Multidisciplinary cooperative first aid model for the treatment of patients with pelvic and multiple fractures

Objectives: To retrospectively evaluate a multidisciplinary cooperative first aid model for the treatment of patients with pelvic and multiple fractures in the emergency department. Methods: The records of patients with pelvic fractures complicated with multiple fractures treated in our hospital from February 2020 to April 2021 were selected, of which 34 patients received conventional trauma first aid mode (control group) and 34 patients received multidisciplinary joint first aid mode (study group). We compared pelvic function (Majeed functional score) and fracture reduction outcomes, as well as serum inflammatory factor levels and complication rates after treatment between the two groups. Results: The Majeed score in the study group (90.15 ± 6.83) was higher than that in the control group (75. 47 ± 5.35), and the differences were statistically significant (P<0.05). The value for combined excellent and good rates of fracture reduction in the study group (85.29%, 29/34) was significantly higher than that in the control group (58.82%, 20/34), and the difference was statistically significant(P<0.05). We found similar levels of TNF-a and IL-6 between the two groups at admission (P>0.05); however, the serum levels of TNF-a and IL-6 in the study group were lower than those in the control group on the fifth day after admission, and the difference was statistically significant (P<0.05 or P<0.01). The incidence of complications in the study group (17.64%, 6/34) was significantly lower than that in the control group (61.76%, 21/34), the difference was statistically significant (P<0.05). Conclusion: The multidisciplinary cooperative first aid model for the treatment of patients with pelvic and multiple fractures can effectively shorten the treatment time, increase the excellent functional rehabilitation rate, inhibit the release of inflammatory factors, and reduce the incidence of complications (such as infections), when compared to the conventional trauma emergency system. doi: https://doi.org/10.12669/pjms.38.3.5014 How to cite this:Han Y, Peng G, Liu L, Xie X. Multidisciplinary cooperative first aid model for the treatment of patients with pelvic and multiple fractures. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Study on Septal Correction: Review of Literature and Clinical Findings

Septal reconstruction has many needs and usages. Nowadays, people are very concerned about looking and would like to correct them. Septal reconstruction has been immensely used in the field of cosmetics. A successful septoplasty would lead us to know about the pathology of the septum by which we can avoid further complications. It would be further significant in nasal obstruction or difficulty in breathing. Deviation of the nasal septum can also be corrected by septal reconstruction by various techniques used for septoplasty. Complete septal reconstruction is the best method for extreme S-shaped and wave-like deviations or multiple fractures. The septoplasty is performed endonasal for caudal septal deviation. Traction sutures to rectify the caudal septum deviation is another type of surgery. Septoplasty usually opens the way for all other rhinoplasty procedures, as a straight, stable septum reflects the attractiveness and functionality of the nose. The patient's history and the surgeon's expertise play a favorable outcome. In conjunction with other nose procedures, such as cosmetic rhinoplasty and endoscopic sinus surgery, Septoplasty is frequently done to alleviate nasal airway obstruction or headaches induced by rhinology irritation produced by touch. Endoscopic septoplasty requires the same amount of time and delivers equal, if not better, results than previous procedures. Visualization is vastly improved by endoscopic technology. Isolated deviation, spurs, perforations, and contact sites are examples of distinct septal disorders that can be treated individually using this procedure. In this review article, the importance of traction sutures is mentioned. The article gives us an idea about Septoplasty and how it can be achieved, its complications, risk factors, and a few postoperative points.

Core Scale FEM Modeling of Thermochemical Fracturing on Cement Cube Samples

Brownfields and depleting conventional resources of fossil fuel energy are not enough to fulfill the tremendously increasing energy demands around the globe. Unconventional oil and gas resources are creating a huge impact on the enhancement of the global economy. Tight rocks are usually located in deep and high-strength formations. In this study, numerical simulation results on a new thermochemical fracturing approach is presented. The new fracturing approach was implemented to reduce the breakdown pressure of the unconventional tight formations. The hydraulic fracturing experiments presented in this study were carried out on ultra-tight cement block samples. The permeability of the block samples was less than 0.005mD. Thermochemical fracturing was carried out by a thermochemical fluids that caused a rapid exothermic reaction which resulted in the instantaneous generation of heat and pressure. Different salts of nitrogen such as sodium nitrite and ammonium chloride were used as a thermochemical fluid. The instantaneous generation of the heat and pressure caused the creation of micro-cracks. The fracturing results revealed that the novel thermochemical fracturing was able to reduce the breakdown pressure in ultra-tight cement from 1095 psi to 705 psi. The reference breakdown pressure was recorded from the conventional fracturing technique. A finite element (FEM) analysis was conducted using commercial software ABAQUS. In FEM, two approaches were used to model the thermochemical fractures namely, cohesive zone modeling (CZM) and concrete damage plasticity models (CDP). The sensitivity analysis of peak pressure and time to reach the peak pressure is also presented in this study. The sensitivity analysis can help in better designing thermochemical fluids that could lead to the maximum generation of micro-cracks and multiple fractures.

Mitigation of Gas Condensate Banking Using an Integrated Chemical Approach

In gas reservoirs, the well production can be reduced due to the development and accumulation of condensate in the near-wellbore zone. Various techniques are used to minimize the condensate damage and maintain hydrocarbon production. Hydraulic fracturing and wettability alteration techniques are the most effective methods. However, these techniques are expensive, especially in deep gas reservoirs. This paper introduces a new approach for mitigating condensate accumulation by integrating the hydraulic fracturing and wettability alteration treatments. The efficiency of two chemicals that can generate multiple fractures and alter the fracture surfaces to less condensate status is investigated in this work. Thermochemical fluids and chelating agent solutions are used to mitigate the condensate damage and improve gas production for the long term. Several laboratory measurements were carried out to study the performance of the proposed approach; coreflooding, zeta potential, and nuclear magnetic resonance (NMR) experiments were conducted. The chemicals were injected into the tight rocks to recover the condensate and improve the flow conductivity. Zeta potential was performed to assess the rock wettability before and after the chemical injection. Moreover, the changes in pores network due to the chemical treatments as analyzed using the NMR technique. Thermochemical treatment removed around 66% of the condensate liquid, while the chelating agent reduced the condensate saturation by around 80%. The main mechanism for condensate removal during thermochemical flooding is the generation of micro-fractures that increase the rock permeability and improve the condensate flow. On the other hand, chelating agents can alter the rock wettability toward less oil-state, leading to considerable recovery of the condensate liquid utilizing a wettability alteration mechanism. Finally, an integrated approach is suggested to injecting thermochemical fluids followed by chelating agent solutions. The proposed technique can lead to generating micro-fractures of less oil-wet surfaces, consequently, the condensate bank can be removed by more than 90%.

Video-Assisted Thoracoscopic Internal Rib Fixation

Rib fractures result in serious morbidity and mortality after trauma. Although there is ongoing debate about surgical rib fixation, it is increasingly important for some patients. Minimally invasive techniques for rib fixation are gaining traction within the trauma community. We present an observational experience at our level 1 trauma center with our first 10 cases of video-assisted thoracoscopic surgery (VATS) internal rib fixation. Video-assisted thoracoscopic surgery internal plates are especially helpful for rib fractures under the scapula, which are difficult to access traditionally. This technique is also excellent at reducing complex segmental fractures as the bridge can span across multiple fractures with a single post on either side. They also work well for posterior fractures where multiple screws cannot be placed. Video-assisted thoracoscopic surgery internal rib fixation is a viable and exciting option for surgical fixation. The plates work particularly well for certain fracture patterns.

Impact of geomechanical heterogeneity on multiple hydraulic fracture propagation

To extract more gas from shale gas reservoirs, the spacing among hydraulic fractures should be made smaller, resulting in a significant stress shadow effect. Most studies regarding the stress shadow effect are based on the assumption of homogeneity in rock properties. However, strong heterogeneity has been observed in shale reservoirs, and the results obtained with homogeneous models can be different from practical situations. A series of case studies have been conducted in this work to understand the effects of mechanical heterogeneity on multiple fracture propagation. Fracture propagation was simulated using the extended finite element method. A sequential Gaussian simulation was performed to generate a heterogeneous distribution of geomechanical properties. According to the simulation results, the difficulty of fracture propagation is negatively correlated with the Young's modulus and Poisson's ratio, and positively correlated with tensile strength. When each of the multiple fractures propagates in a homogeneous area with different mechanical properties, the final geometry of the fracture is similar to homogeneous conditions. When the rock parameter is a random field or heterogeneity perpendicular to the propagation direction of fracture, the fracture will no longer take the wellbore as the center of symmetry. Based on the analysis of fracture propagation in random fields, a small variance of elastic parameters can result in asymmetrical propagation of multiple fractures. Moreover, the asymmetrical propagation of hydraulic fractures is more sensitive to the heterogeneity of Poisson's ratio than Young's modulus. This study emphasises the importance of considering geomechanical heterogeneity and provides some meaningful suggestions regarding hydraulic fracturing designs.

Prediction of Vertebral Fractures by Trabecular Bone Score in Patients With Ankylosing Spondylitis

Ankylosing spondylarthritis (AS) is associated falsely increased lumbar spine bone mineral density (BMD). New tool for discrimination of subjects at fracture risk is needed. Vertebral fracture (VF) prediction of routine methods for osteoporosis assessment, BMD and trabecular bone score (TBS), in patients with AS. Cross-sectional study of all AS patients regularly followed at the rheumatology outpatient clinics of two centers. All subjects undergone BMD measurement at lumbar spine (LS), total hip (TH) and femoral neck (FN) using Hologic® Horizon device. TBS at L1-4 in all subjects by TBS InSight® software were assessed. Vertebral fracture assessment (VFA) was performed using the lateral spine imaging IVA™ and graded using Genant semi-quantitative approach. 119 AS subjects (90 males/29 females), mean age 47.6 years were included in the study. In 20 patients 34 VFs were detected, from whom 7 patients had multiple fractures. Subjects with VF were older and had lower FN BMD, TBS in comparison to non-VF subjects. No differences in LS BMD, FN BMD or BASDAI between groups were observed. Among patients with VF only 3 had T-score less than -2.5 but 7 has TBS less than 1.23 which means highly degraded microarchitecture. AS patients with VF have lower TBS and FN BMD in comparison to non-VF subjects. In addition, TBS was able to detect 20 % more VFs than BMD. Therefore, TBS seems promising in VF discrimination among patients with AS.

Fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures from population health data in Ontario

Background Understanding the profiles of different upper extremity fractures, particularly those presenting as a 1st incident can inform prevention and management strategies. The purpose of this population-level study was to describe first incident fractures of the upper extremity in terms of fracture characteristics and demographics. Methods Cases with a first adult upper extremity (UE) fracture from the years 2013 to 2017 were extracted from administrative data in Ontario. Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve, or tendon injury) were described by fracture type, age category and sex. Standardized mean differences of at least 10% (clinical significance) and statistical significance (p < 0.01) in ANOVA were used to identify group differences (age/sex). Results We identified 266,324 first incident UE fractures occurring over 4 years. The most commonly affected regions were the hand (93 K), wrist/forearm(80 K), shoulder (48 K) or elbow (35 K). The highest number of specific fractures were: distal radius (DRF, 47.4 K), metacarpal (30.4 K), phalangeal (29.9 K), distal phalangeal (24.4 K), proximal humerus (PHF, 21.7 K), clavicle (15.1 K), radial head (13.9 K), and scaphoid fractures (13.2 K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8 K), fractures occurring in multiple regions of the upper extremity (8.7 K), or multiple regions in the forearm (8.4 K). Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries were rarely reported (0.3% overall, 1.5% in distal humerus). Fractures were reported as being open in 4.7% of cases, most commonly for distal phalanx (23%). A similar proportion of females (51.5%) and males were present in this fracture cohort, but there were highly variant age-sex profiles across fracture subtypes. Fractures most common in 18–40-year-old males included metacarpal and finger fractures. Fractures common in older females were: DRF, PHF and radial head, which exhibited a dramatic increase in the over-50 age group. Conclusions UE fracture profiles vary widely by fracture type. Fracture specific prevention and management should consider fracture profiles that are highly variable according to age and sex.

Forensic examination of a dog's corpse with signs of violent death: A case review

Increasingly, in the media, social networks, we encounter reports of cruelty to animals by companions, which led to their injury or death. Animal cruelty in Ukraine and all over the world, unfortunately, still remains an urgent problem. In this regard, forensic investigators ask veterinary experts questions that are aimed at assessing the severity of the damage, the mechanism of their formation and establishing the cause of death of the animal. According to the pre-trial investigation and the forensic veterinary examination results of the corpse of a dog, which was conducted at the request of investigative authorities in the inquiry of a criminal offense on the grounds of a crime under Part 1. Article. 299 of the Criminal code of Ukraine, the open craniocerebral trauma of a head of a dog with multiple fractures of the facial bones is established. The left eyeball is missing. There is a rupture of the muscular base and the mucous membrane of the tip of the tongue. Open fracture of the mandible with the discrepancy between the symphysis of the right and left arches. During the necropsy, it was noted that the subcutaneous tissue contains a small amount of fat, skeletal muscle is moderately developed, the stomach is empty and the dog's corpse is exhausted. Which indicates that the dog has spent a loong time without proper care of the pet owner. A torn-scalped wound with signs of purulent inflammation and the presence of fly larvae was noted in the head area, which may indicate that the process is 3–7 days old. Extensive left hemorrhage in the meninges of the frontal area and generalized cerebral edema caused by momentary action of a mechanical factor, a blow in the lateral direction were observed during the study of the brain. Traumatic injuries found on the dog's corpse have a lifetime character and are in a direct causal relationship between the injuries and the cause of death of the animal.

Falls From Height, Facial Injuries and Fatalities: An Institutional Review

Study Design Retrospective cohort review. Objective To investigate the relationship between falls from height and facial injuries. Methods This is a retrospective cohort study, conducted over a 7-year period, of the medical records of all patients who presented to hospital for a maxillofacial injury following a fall from height. Fall heights were classified as low falls (1–3 m), high falls (3–10 m) and very high falls (≥10 m). Results A total of 111 patients with 218 facial bone fractures were identified (78 men, 33 women and mean age 50.3 years). High falls were the most common (n = 58, 52.3%). Multiple fractures were identified in 51 (46.0%) patients. Orbital and middle third fractures were the most prevalent. Nasal, mandible, bilateral and fractures involving more than one facial third, increased as fall height increased, as did the requirement for operative fixation. The majority of patients had an associated injury (n = 100, 90.1%) and overall mortality was 6.3%. Conclusions Falls from height are prevalent and there is a trend towards increased severity of facial injury, surgical intervention and associated morbidity as fall height increases. Falls from height are a significant public health concern and an important facet of maxillofacial trauma to recognise, as is the requirement for an interdisciplinary approach as they present to hospital.