scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

scholarly journals Major trauma patients are not who you might think they are: a linked data study

2019 ◽  
Vol 16 ◽  
Author(s):  
Elizabeth Brown ◽  
Hideo Tohira ◽  
Paul Bailey ◽  
Daniel Fatovich ◽  
Judith Finn
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Categorical Variables ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Mechanism Of Injury ◽  
Young Males

IntroductionMajor trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.MethodsThis is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days). ResultsA total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001). ConclusionMajor trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.

scholarly journals A prospective observational study on the optimal management approach based on the clinical profile of renal trauma patients

2020 ◽  
Vol 7 (11) ◽  
pp. 1677
Author(s):  
Soumish Sengupta ◽  
Supriyo Basu ◽  
Kadambari Ghosh ◽  
Subhrajyoti Sengupta
Keyword(s):  
Observational Study ◽  
Renal Injury ◽  
Prospective Observational Study ◽  
Renal Involvement ◽  
Penetrating Trauma ◽  
Standard Of Care ◽  
Clinical Profile ◽  
Renal Trauma ◽  
Management Approach ◽  
Trauma Patients

Introduction: The kidney is the most commonly injured genitourinary organ following trauma. It can be a result of both blunt and penetrating trauma to the abdomen. Both conservative and surgical managements are employed as per the clinical profile of the patient.Methods: This prospective observational study included all the patients with renal trauma who presented at the ER. Computed tomography (CT) was done for grading of renal trauma.Results: A total of 60 patients were included in the study. Eighty percent (n=48) patients were managed conservatively. Twenty percent (n=12) patients underwent some form of surgical management. The mean (SD) hospital stay as 11.38 (6.94) days. Twenty-eight patients (46.67%) had right renal injury. Thirty-two patients (53.33%) had left renal involvement. There were no patients with bilateral renal injury. According to American association for the surgery of trauma (AAST), 11.66% patients (n=7) were categorised in grade I, 20% patients (n=12) to grade II, 33.33% patients (n=20) to grade III, 25% patients (n=15) to grade IV and 10% patients (n=6) to grade V. The most common associated injuries were rib fracture and visceral injury.Conclusion: Much has changed since historical times with regards to renal trauma management. Data from various studies point towards a paradigm shift from surgical to conservative management as the standard of care irrespective of the grade and mode of renal trauma.

scholarly journals Low-Energy Multiligament Knee Injuries Are Associated With Higher Postoperative Activity Scores Compared With High-Energy Multiligament Knee Injuries: A Systematic Review and Meta-analysis of the Literature

2020 ◽  
pp. 036354652096208
Author(s):  
Robert S. Dean ◽  
Nicholas N. DePhillipo ◽  
David H. Kahat ◽  
Nathan R. Graden ◽  
Christopher M. Larson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Vehicle ◽  
Meta Analysis ◽  
Knee Injuries ◽  
High Energy ◽  
Low Energy ◽  
Vehicle Accidents ◽  
Injury Mechanisms ◽  
Outcome Scores ◽  
Multiligament Knee Injuries

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from <5 feet. A meta-analysis was performed comparing the outcome scores of high- versus low-energy mechanisms of MLKIs. Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Meike Schuster ◽  
Natasha Becker ◽  
Amanda Young ◽  
Michael J Paglia ◽  
A Dhanya Mackeen
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
Vaginal Deliveries ◽  
Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

scholarly journals Pilon Fracture: A Case Report of a 45-Year-Old Dental Technician

2014 ◽  
Vol 8 (1) ◽  
pp. 433-436 ◽  
Author(s):  
Pouya Mafi ◽  
James Stanley ◽  
Sandip Hindocha ◽  
Reza Mafi
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Motor Vehicle ◽  
High Energy ◽  
Tibial Fractures ◽  
Pilon Fracture ◽  
Distal Tibial Fractures ◽  
Vehicle Accidents ◽  
Dental Technician ◽  
Fall From Height

Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

Observation and treatment of renal trauma: 3 years experience

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 113-115
Author(s):  
F. Cappellano ◽  
F. Catanzaro ◽  
E. Della Morte ◽  
M. Baruffi ◽  
F. Torelli ◽  
...  
Keyword(s):  
Ct Scan ◽  
Renal Injury ◽  
Penetrating Injury ◽  
Renal Trauma ◽  
Trauma Patients ◽  
Radiological Investigation ◽  
Long Term Follow Up

The investigation and management of renal trauma have evolved during the last 15 years. The majority of patients with renal trauma can be treated conservatively with minimal radiological investigations, since the outcome is excellent in most cases. A CT scan is the radiological investigation of choice in most cases of renal trauma when the patient is hemodynamically stable and there is suspicion that he has suffered a major renal injury. Long term follow-up of renal trauma patients treated conservatively is needed to examine possible complications. We report our experience on 87 patients presenting a complication in a penetrating injury.

scholarly journals Hepatothorax: A Rare Outcome of High-Speed Trauma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew Porcelli ◽  
Oksana Prychyna ◽  
Andrew Rosenthal ◽  
Joseph DeCostanza
Keyword(s):  
Early Diagnosis ◽  
High Speed ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Motor Vehicle Crashes ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Common Mechanism ◽  
Trauma Unit ◽  
Level I

Diaphragmatic ruptures are the result of severe blunt trauma or penetrating trauma. Motor vehicle crashes are a common mechanism associated with blunt diaphragmatic rupture (BDR). Incorporating diagnostic tools and laparotomy assist in the diagnosis and treatment of BDR. However, diagnosing BDR can be a challenge for practitioners. Early diagnosis and treatment improve the patient's outcomes. This paper details the events of a patient received in a level I trauma unit.

The Burden of Trauma in Kosova: A Post Card Report from Prishtina

2014 ◽  
Vol 3 (1) ◽  
pp. 29-32
Author(s):  
Rifat Latifi ◽  
Fransisco Mora ◽  
Basri Lenjani ◽  
Kalterina L Osmani ◽  
Lirije Beqiri ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Injury Rate ◽  
Public Health Issue ◽  
Mortality Data ◽  
Trauma Patients ◽  
Post Card ◽  
Tertiary Center ◽  
Card Report

ABSTRACT Introduction Kosova, an independent country since 2008 in Southern Europe, has experienced increased urbanization and development. Despite this young country's advances, its healthcare infrastructure has progressed at a much slower rate and limitations are particularly notable in trauma care. This combination has made trauma a major public health issue in Kosova. The University Clinic Center of Kosova (UCCK) in Prishtina is the only tertiary center that serves the entire country. Materials and methods A retrospective review of data collected from a combination of local sources, as there is no one agency or department that has all the data. These sources include: (1) the emergency department (ED) of UCCK (data from 2007-2012), admissions hospital data from UCCK (2004- 2009), and motor vehicle collisions (MVC) data provided by the Prishtina police department (2008-2012). However, the main source of patients data analyzed in this study was provided from the ED. Throughout this study rate calculations are based on the population of Prishtina (198,330 inhabitants as reported in the last national census). Results Twenty-four thousand one hundred and ninety-nine trauma patients were treated at UCCK ED between 2007 and 2012, of which 93.5% were blunt trauma and 6.3% penetrating trauma. There were 285 fatalities with a mortality rate varying between 16.6 and 37.3 for 100,000 inhabitants. UCCK in-patient data from 2004 to 2009 reported 193 fatalities due to MVC, with a mortality rate between 10.08 and 23.1 per 100,000 inhabitants. Prishtina police reported 214 MVC-related deaths on the streets of Prishtina, with a mortality injury rate between 16.13 and 27.22 per 100,000 inhabitants from 2008 to 2012. However, combined mortality data for 2009 yields an MVC mortality rate of 61 per 100,000 inhabitants, the highest in the world. Conclusion Trauma burden remains a substantial public problem in Kosova, and needs to be addressed acutely. Furthermore, there is urgent need for a nationwide trauma registry, in order for policymakers to be able to recognize the gravity of the situation and to design and implement appropriate interventions and allocate already limited funding. How to cite this article Mora F, Lenjani B, Osmani KL, Beqiri L, Hoxha Z, Hajdari F, Latifi R. The Burden of Trauma in Kosova: A Post Card Report from Prishtina. Panam J Trauma Crit Care Emerg Surg 2014;3(1):29-32.

scholarly journals Traumatic diaphragmatic hernia: 28-years analysis at a Brazilian university hospital

2020 ◽  
Author(s):  
Vitor Kruger ◽  
Thiago Calderan ◽  
Rodrigo Carvalho ◽  
Elcio Hirano ◽  
Gustavo Fraga
Keyword(s):  
Diaphragmatic Hernia ◽  
Chest Radiography ◽  
Motor Vehicle ◽  
Morbidity And Mortality ◽  
University Hospital ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Abdominal Injuries ◽  
Traumatic Diaphragmatic Hernia

Abstract Background The objective of the study is evaluate the approach to patients with acute traumatic diaphragmatic hernia at a Brazilian university hospital during a 28-year period. Traumatic diaphragmatic hernia is an uncommon injury, however its real incidence may be higher than expected. Sometimes is missed in trauma patients, and is usually associated with significant morbidity and mortality, this analysis may improve outcomes for the trauma patient care.Methods Retrospective study of time series using and analisys database records of trauma patients at HC- Unicamp was performed to investigate the incidence, trauma mechanism, diagnosis, herniated organs, associated injuries, trauma score, morbidity, and mortality of this injury.Results Fifty-five cases were analyzed. Blunt trauma was two-fold frequent than penetrating trauma, are associated with high grade injury and motor vehicle collision was the most common mechanism. Left side hernia was four-fold frequent than right side. Diagnose was mostly performed by chest radiography (31 cases; 56%). Associated intra-abdominal injuries were found in 37 patients (67.3%) and extra-abdominal injuries in 35 cases (63.6%). The mortality was 20% (11 cases).Conclusions Computed tomography scan identified associated injuries and had high specificity. Isolated injuries were rare, and the presence of associated injuries increased morbidity and mortality. Despite advances in imaging methods, chest radiography in the trauma bay is useful as an initial approach. Despite the use of laparoscopy in a few cases, laparotomy was the most frequent approach for repair.

scholarly journals Fractures of the femoral head: a narrative review

2021 ◽  
Vol 6 (11) ◽  
pp. 1122-1131
Author(s):  
Maximilian M. Menger ◽  
Benedikt J. Braun ◽  
Steven C. Herath ◽  
Markus A. Küper ◽  
Mika F. Rollmann ◽  
...  
Keyword(s):  
Femoral Head ◽  
Surgical Approach ◽  
Motor Vehicle ◽  
Hip Dislocation ◽  
High Energy ◽  
Femoral Head Fracture ◽  
Concomitant Injuries ◽  
Vehicle Accidents ◽  
Joint Congruity

Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

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