Does the Nail Bed Regenerate?

Background: The regenerative potential of the nail bed after trauma remains controversial. Methods: We performed a retrospective review of 51 patients who underwent nail bed reconstruction with 2 techniques (direct flow island flap or a Tranquilli-Leali “Atasoy” flap) due to trauma involving the nail bed complex. These 2 flaps were used to support the loss of distal substance and to allow the regeneration of the nail bed. Outcomes were analyzed for at least 18 months. There were 34 men (66.7%), and the average age was 16.1 years. Most patients (56.9%) had crush injuries. The little (16) and index (14) fingers were the most affected. Twenty-seven were children (range: 4-11) with an average age of 7.4 ± 1.9 years. The middle finger was the most affected (29.2%). Results: The outcomes were good to excellent in 41 operated patients (80.4%). Hook nail was absent in 84.3% of the patients. Most patients (98%) did not develop necrosis. Children had an excellent/good outcome rate of 85.2%, while in adults, the rate was 75% of cases ( P = .485). Conclusion: The direct flow island flap is superior in terms of outcome, regardless of age, sex, affected finger, dominant hand, type of trauma, and injury zone. In cases where there was a correct reconstruction of the hyponychium, there was regeneration of the nail bed.

Child Writing and the Traumatised Body

Texts by young conflict survivors, including the children of Hiroshima and Nagasaki, are worthy of historical and literary consideration on many fronts. How did young people experience, understand, and cope with damage to their bodies? What stigma did they face, and how did they make sense of their changed futures? How did they translate their experiences into prose, and how did they negotiate the meanings that such prose held within their societies? This essay suggests that juvenilia offers a deep well for other fields—trauma studies, the history of childhood, and even disability studies—to consider, and juvenilia studies might also incorporate new theoretical apparatuses that can help elucidate the personal, social, and political implications of young writers’ experiences of trauma and injury. Attention to children’s writing about their injuries may approach the asymptote of their trauma and offer insights for scholars working from numerous disciplinary points of origin. .

Building evidence to reduce inequities in management of pain for Indigenous Australian people

Objectives Pain is a universal experience which each person encounters differently, guided by the psycho-socio-environmental context in which it occurs. Although more research is underway yet very little is known about pain from Indigenous Australian perspective. Therefore, this study aims to examine, experience of pain and coping, and utility of three measures: Brief Pain Inventory short form, McGill Pain Questionnaire and Numerical rating scale, from Indigenous South Australian people perspective. Methods Thirteen in-person interviews were conducted which lasted around 90 min and were audio-recorded. The transcripts were coded and analysed thematically with NVivo. Results Six key themes were identified; 1: Spiritual conceptualisation of pain; 2: Frequent experience of trauma and injury; 3: Influence of familial history of pain; 4: Acceptance of pain as normal; 5: Outlook on biomedical management of pain; 6: Preference for non-pharmacological management of pain. Also, the three measures did not fully capture pain from an Indigenous Australian perspective which is more deeply rooted in a bio-psycho-socio-spiritual context which is cardinal to conceptualization of health and wellbeing in Indigenous Australian communities. Conclusions Findings highlight some commonalities as well as unique differences between Indigenous experiences of pain as compared to non-Indigenous. Factors such as spiritual connection with pain, grief and loss, history of trauma and injury, fear of addiction to pain medication and exposure to pain from early childhood had important implications for how participants viewed pain.

Study of the efficacy of trauma and injury severity score to predict survival in patients of polytrauma

Background: Trauma is one of the major cause of mortality and morbidity in both developed and developing countries. Polytrauma patients present particular challenges as profile of the patient varies with different types and severity of injuries. Prediction of survival in trauma patients is an essential requirement of trauma care. Trauma and injury severity score (TRISS) have been considered as a standard of the quality of trauma care. Study was carried out to evaluate the performance of TRISS in predicting survival in patients of polytrauma.Methods: Prospective observational study was conducted in emergency department of a tertiary care centre. 100 patients were evaluated in the study for a period of 18 months between November 2019 and April 2021. Patient demographics, details of trauma, pattern of injuries and physiological status were recorded. Overall outcome were studied and data analysis was done on the basis of TRISS. Statistical analysis was performed using statistical package for the social sciences (SPSS) program for windows, version 25.0 (SPSS Chicago, Illinois).Results: Young patients with mean age of 34.54 were most commonly affected in polytrauma with male preponderance. Road traffic accidents were the most common mode of trauma followed by fall from height. Blunt trauma was the most common type of injury. TRISS strongly predicted survival in polytrauma patients (AUC 0.926 CI 95% 0.868-0.985). TRISS has high sensitivity 97.62% and specificity 62.50% at a cut off of 64.50%.Conclusions: TRISS is an effective method for predicting survival of polytrauma patients and thus can be utilized to evaluate and compare trauma care.

BIOMECHANICS OF PENETRATING TRAUMA AND INJURY MITIGATING PROTECTIVE MEASURES IN GUARDRAIL MOTOR VEHICLE CRASHES

The objective of the present study is two-fold. First, the elucidation of the biomechanics of penetrating trauma as a result of guardrail intruding into the occupant compartment. Second, the evaluation of the biomechanical efficacy of hybrid tension-compression guardrails to better protect occupants. The nine fatally guardrail penetrating crashes occurred between 2016 and 2019 were analyzed to study the mechanism of injuries. Four car-to-guardrail crash tests were conducted using a hybrid guardrail that integrated the commonly used W-beam with a new design of tension-based end terminal. The test included the impact of a bogey-type platform, small sedan vehicles, and a pick-up truck at highway speeds onto the guardrail. The impact orientation was varied to simulate the frontal and oblique corner crashes with a speed ranging from 90 to 111 kph. The real-world studies showed that the fatal injuries were due to impaling guardrail regardless of vehicular speed and size. The occupants not in the trajectory of the guardrail in the same vehicle sustained minor injuries despite experiencing a similar energy level. In these cases, the crash severity was survivable without the guardrail penetration. The mean pre-impact speed, change in speed, and vehicular acceleration was 117 kph, 20 kph, and 97 m/sec2, respectively. The hybrid guardrail system deflected the vehicle without any penetration into the occupant compartment. The mean peak accelerations in crash tests were below injurious threshold levels. The present research shows that the hybrid guardrail system not only eliminated the intrusion into occupant survival space but also deflected the vehicle.

Adjustment of Trauma and Injury Severity Sccore (TRISS) and Revised Trauma Score (RTS) in Predicting Mortality of Multitraumapatients in Sanglah Hospital Bali

Background: The Trauma and Injury Severity Score (TRISS) is the most applied tool to predict the multi-trauma outcome. It is shown that the predictive value of TRISS could be improved by adjusting the coefficient. Originally this study aims to evaluate our hospital in treating multitrauma patients, with good outcome we propose adjustment to TRISS formula. Methodology:This study is a diagnostic test to determine the accuracy of TRISS scores to predict mortality of multitrauma patients treated in Sanglah General Hospital. Result: Fifty two multitrauma patients with ISS score > 18 with at least 2 body regions being injured. The TRISS diagnostic test was obtained with a sevsitivity 81.8%, specificity 97.6%, positive predictive value 90%, negative predictive value 95.2%, prevalence 21%, accuracy rate of 94.2%. Conclusion: Adjustment to TRISS formula coefficient for better prediction is proposed. Physiological parameter in RTS that does not include respiratory rate shows reliable prediction, which can be used in emergency setting when anatomical diagnostic has not yet to be obtained.