Blog Elements – Page 51 – Trauma International

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:53-55 | Wasudeo Gadegone, Vijayanad Lokhande, Yogesh Salphale Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1] [1] GMC Chandrapur, Maharashtra, India. [2] Shushrusha Multispecialty hospital, Chandrapur, India. [3] Smt. Kashibai Navale Medical College and General Hospital, Pune Address of Correspondence Dr. W.M. […]

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:40-43 | Ranjeet Kumar, Muhammad Muzzammil, Muhammed Saeed Minhas, Anisuddin Bhatti, Vinod Kumar, Syed Jahanzeb. Author: Ranjeet Kumar [1], Muhammad Muzzammil [1], Muhammed Saeed Minhas [1], Anisuddin Bhatti [1], Vinod Kumar [1], Syed Jahanzeb [1]. [1] Jinnah Postgraduate Medical centre Karachi, Pakistan. Address of […]

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Full Sized Blog Element (Big Preview Pic)

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:53-55 | Wasudeo Gadegone, Vijayanad Lokhande, Yogesh Salphale

Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1]

[1] GMC Chandrapur, Maharashtra, India.
[2] Shushrusha Multispecialty hospital, Chandrapur, India.
[3] Smt. Kashibai Navale Medical College and General Hospital, Pune

Address of Correspondence
Dr. W.M. Gadegone.
VivekNagar Mul-Road Chandrapur 442402, Maharashtra, India.
Email: gadegone123@yahoo.co.in

Abstract

Conservative treatment remains the gold standard in treatment of simple undisplaced midshaft clavicle fractures, but for displaced and comminuted fractures surgical intervention is appropriate especially in young active adults. Surgical stabilisation can be achieved using either a plate or an intramedullary device. One of dreaded complication of intramedullary device in migration of the implant. We have used a screw intramedullary device with screw mechanism at one end which can get hold in the medial cancellous bone, thus preventing chances of migration. This report describes the technique of using the screw intramedullary nail for displace clavicle fracture.
Keywords: clavicle fracture, intramedullary nailing.

Introduction

Although conservative treatment is the gold standard for clavicle fractures, there may be some issues like shoulder impairement, a bump at the fracture site that is cosmetically unacceptable or nonunions which happen when grossly displaced fractures are treated conservatively. Surgical stabilisation may be additionally indicated in cases with completely displaced fractures (gap of > 20mm), potential skin perforation, shortening of clavicle by more than 20 mm, neurovascular injury, and floating shoulder injury. Plating is an option which is used commonly, but leads to scarring and may need repeat surgery of implant removal. Intrameduallry nailing has been successfully used by few authors but has a complications like nail migration. We are using a screw intrameduallry device (Fig. 1) which anchors to the metaphyseal bone by the wide screw head at the end of the nail. This technicaal note simply describes the technique.

Implant

Screw elastic intramedullary nail is available in diameter of 2, 2.5, and 3 mm. The nails are 5-6 cm in length , with screw portion of 10mm length and 4.5mm in diameter. The screw head is of 3.5 mm size where the appropriate screw driver fits (Fig. 1). The nail is made of either steel of titanium and is sufficiently elastic to bend as it traversed the canal from the point of insertion and resilient enough to spring back in the curvature when finally seated. However it is still rigid enough to withstand the torsional, rotational, and angulatory forces.]Nail has a bevelled tip at one end and a threaded head positioned at other. This design allows the self-cutting thread to be advanced and screwed in with a 3.5 mm screw driver. The distal beveled end of the nail aids in fracture reduction and helps in engaging in the subchondral area of the bone, thereby imparting stability. The inserter should firmly grasp the nail in order to control rotation, insertion and nail withdrawal. It is best to mount the nail on a T handle while inserting but other devices can also be used (Fig. 2)

Surgical Technique:

Operative procedure is carried out under interscalanae block or general anaesthesia. Affected shoulder is elevated by a bolster so that clavicle becomes more prominent. This position also helps to restore length and increase exposure of the clavicle (Fig. 3). The procedure is performed under fluoroscopic guidance. A one centimeter skin incision is made over medial end of clavicle and a hole is drilled in the anterior cortex with a 3.2 mm drill bit and guide. The insertion point is made approximately 1 cm lateral to the sternoclavicular joint. The entry portal is then enlarged with an awl (Fig.3).

The reaming of canal is done with sequential reamer and then an elastic nail of appropriate diameter and length is inserted in the medullary canal of clavicle with a universal chuck and T-handle (Fig. 4).

With oscillating movements the nail is advanced until it reaches the fracture site. With the help of percutaneously placed towel clips fracture fragments are approximated (Fig. 5). The reduction is checked in image-intensifier and then the nail is advanced through the fracture site till it reaches distal end of clavicle. Generally nail can be negotiated one cm short of acromioclavicular joint. If closed reduction is unsuccessful, an additional skin incision is made at fracture site for open reduction of the fragments (Fig. 5).

Although clavicle is S shaped, tip of the nail is curved which helps the surgeon to pass the elastic nail into distal fragment. After adequate engagement of the distal fragment, the medial end of screw nail is screwed in the metaphyseal region of the medial end of clavicle and skin closed over it (Fig. 6).

Postoperatively arm pouch sling is given for three weeks. Gentle pendulum exercises of the shoulder are allowed as per pain tolerance immediately after surgery. We tend to limit extreme overhead activities for 3-6 weeks. At four to six weeks, active assisted range of motion in all planes was allowed. When fracture union (defined as radiographic union with no pain or motion with manual stressing of the fracture) was evident, muscle strengthening exercises were also allowed. At eight to twelve weeks, Isometric and isotonic exercises were prescribed for shoulder girdle muscles with return to full activities (including sports) at three months (Fig. 7).

Conclusions

Percutaneous elastic screw intramedullary nailing of the clavicle is a safe, reliable method for fixation of displaced midshaft clavicle fractures. It is less invasive and allows rapid healing by callus formation. Complication rates are low, with better functional and cosmetic results.

How to Cite this article: Gadegone W, Lokhande V, Salphale Y. The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note. Trauma International May – Aug 2016;2(2):53-55.

(Abstract) (Full Text HTML) (Download PDF)

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:40-43 | Ranjeet Kumar, Muhammad Muzzammil, Muhammed Saeed Minhas, Anisuddin Bhatti, Vinod Kumar, Syed Jahanzeb.

Author: Ranjeet Kumar [1], Muhammad Muzzammil [1], Muhammed Saeed Minhas [1], Anisuddin Bhatti [1], Vinod Kumar [1], Syed Jahanzeb [1].

[1] Jinnah Postgraduate Medical centre Karachi, Pakistan.

Address of Correspondence
Dr Nadeem A Faruqui
14/116d, Civil Lines,
Kanpur 208001 India
Email: nafaruqui@hotmail.com

Abstract

Background: Road safety is an important public health issue in Pakistan. The aim of this study was to investigate trends in road traffic accidents (RTCs) managed by accident and emergency department in Karachi, Pakistan’s largest city, their age and gender distribution and impact of religious month, Ramadan and Eid on frequency of Road traffic accidents in Karachi
Design: cross-sectional study.
Place and duration of study: Accident & emergency department of Jinnah Post Graduate Medical Center, Civil hospital, Abbasi Shaheed Hospital, Aga Khan hospital and Liaqat Hospital Karachi. Pakistan from Jan 2014 to December 2014.
Patients and Methods: A descriptive cross-sectional study was carried out by ROAD TRAFFIC INJURY RESEARCH AND PREVENTION CENTRE “RTIR&PC” in the five tertiary care hospitals (Civil Hospital ,Jinnah Postgraduate Medical Center, Abbasi Shaheed Hospital and Aga Khan Hospital) of Karachi, Pakistan. All road traffic accident victims presented to the emergency department of the selected hospital, were included in the study. A pretested trauma registry form was completed for all patients.
Results: Total numbers of accidents were 24360 and total number of injured were 30274. Minor injury 23825 approximately 78.6%, around 65 per day, serious were 5382 approximately 17%,around 15 per day and fatal were 1067 approximately 3.5%, 3 per day. Male injured were 25263 around 83% and female were 5011 around 17%. According to casualities with respect to age were from 16-20 years male were 5136 around 20% and female were 553 around 11% total of 5689 , from 21-25 years male were 4785 around 19% and female were 674 around 13% total of 5459 , from 26-30 years male were 3546 around 14% and female were 613 around 12% total of 4159 and under 15 years male were 3165 around 13% and female were 840 around 19% total of 4105 , other age and gender distribution given in table 1. On month wise casualities, highest casualities recorded in month of June and July of 2014. Ramadan was from June to July in 2014 and Eid was in July in 2014. In June 2014 injured were 3080 around 11% and fatal were 72 around 7% and in July 2014 injured were 3506 around 12% and fatal were 112 around 10 %. Record of other months casualities given in table 2. Injuries related to body part were , head and neck 23% ,fatal were 53%, face 17% ,fatal were 16%, chest 1% fatal 1%, abdomen, pelvic contents 1% fatal 1%, extremity, pelvic girdle 29% fatal 17% external injuries 28% fatal 12%.
Conclusion: The study has described trends of RTAs managed by emergency department of hospitals in karachi. Hospital of Karachi experienced a higher burden of RTAs emergencies in the month of Ramadan 2014 as compared with the preceding months of the year. This increase was mostly concentrated among younger ages range from 16-25 years of age. Injuries in city of Karachi are an important public health problem and contribute to major bulk of Emergency facilities. These accidents and the resultant injuries have considerable physical and socioeconomic impacts; therefore, this issue needs to be addressed. By putting into effect laws that enforce road safety measures and helmet usage can prevent these injuries.
Keywords: RTAs (Road traffic accident).

Introduction

Road traffic crashes (RTAs) are one of the most pressing international health and development concerns in the world. Every year, nearly 1.3 million people die as a result of a road traffic collision – more than 3000 deaths each day – and more than half of these people are not travelling in a car. . It was the 2nd leading cause of deaths among 15 – 44 years of age and 80% of these deaths occurred in developing countries . According to the World Health Organization (WHO) 2011 fact sheet, “over 90% of the world’s fatalities on the roads occur in low-income and middle-income countries, even though these countries have less than half of the world’s vehicles [1,2]. In Pakistan, half of all major incidents and two thirds of all deaths in major incidents are due to RTAs In Pakistan [3]. In Pakistan the incidence of road traffic injuries to be around 15–17 per 1000 persons per year estimated by two independent population-based surveys [4–6]. It is estimated that approximately 40 000 people die on the roads every year in Pakistan and many more sustain serious injuries [6]. In addition to the suffering, these injuries contribute significantly to the workload in hospitals, leading to direct costs to the Pakistani economy of over US$ 1 billion [4,7,8]. Various studies in many countries have raised the issue of the increased number of RTCs during holidays and festive periods such as Christmas and New Year [9–11]. An increasing trend of RTAs has also been documented, In countries that celebrate Ramadan, Eid al-Fitr and Eid al-Adha, [12-15]. Ramadan is the ninth month of the Islamic calendar and lasts 29 or 30 days. It is the Islamic month of fasting, in which participating Muslims refrain from eating, drinking, smoking and sex during daylight hours

Methods

It is cross sectional study conducted by Road Traffic Injury Research And Prevention Centre “RTIR&PC” in emergency department of all five major hospitals in Karachi including Jinnah Postgraduate Medical Center, Civil hospital, Abbasi Shaheed Hospital, Aga Khan Hospital and Liaqat Hospital Karachi. . All road traffic accident victims presented to the emergency department of the selected hospital, were included in the study. Inclusion criteria were injured patients of any age or sex presenting to the Accident, Emergency . A pretested trauma registry form was completed for all patients. If the patient was brought unconscious, an attempt was made to collect the information from the patient’s attendant. Basic demographic characteristics, time and date, nature and cause of injury, vital signs and outcome data were recorded. Type of vehicle and mode of collision was recorded in cases of road traffic accident.

Results

Total numbers of accidents were 24360 and total number of injured were 30274. Minor injury 23825 (78.6%), around 65 per day, serious were 5382(17%), around 15 per day and fatal were 1067 (3.5%), 3 per day(table-1, Fig-1).

Male injured were 25263 around 83% and female were 5011 around 17%. According to casualities with respect to age were from 16-20 years male were 5136 around 20% and female were 553 around 11% total of 5689 , from 21-25 years male were 4785 around 19% and female were 674 around 13% total of 5459 , from 26-30 years male were 3546 around 14% and female were 613 around 12% total of 4159 and under 15 years male were 3165 around 13% and female were 840 around 19% total of 4105 (table-2, Fig-2).

On month wise casualities highest casualities recorded in month of June and July of 2014 . Ramadan was from June to July in 2014 and Eid was in July in 2014. In June 2014 injured were 3080 around 11% and fatal were 72 around 7% and in July 2014 injured were 3506 around 12% and fatal were 112 around 10 % (table-3, Fig-3).

Injuries related to body part were , head and neck 23% ,fatal were 53%, face 17% ,fatal were 16%, chest 1% fatal 1%, abdomen, pelvic contents 1% fatal 1%, extremity, pelvic girdle 29% fatal 17% external injuries 28% fatal 12%(fig-4).

Discussion

Trauma is increasingly recognized as a global public health epidemic. WHO has predicted that trauma will rise from 9th leading burden of disease in 1990 to third leading cause in 2020 worldwide . The results of this study revealed a growing rate of RTAs in June and July 2014 (the Islamic month of Ramadan and Eid). In this month, the number of RTAs was higher than the RTAs per month. In present study we found that annual incidence of trauma in road traffic accidents are commonly affecting younger group from 16 -25 years age which also have the highest fatality percentage among all road traffic accidents. In the present study, young age group were predominately involved in the reported RTAs. Fractures of extremities ,external and head injuries were the major injuries sustained by these young people. We also found out that head and neck injuries are the commonest cause of fatality in these incidences. Similar findings have also been reported in research studies from Pakistan [4–8,16-18], India [19-22] and other countries [23-29]. In Ramadan as people wish to be at their homes before iftar (the evening meal when Muslims break their fast). Thus, to return home early, drivers may become impatient and violate traffic rules (e.g. signal violations, speeding, overtaking), often resulting in different forms of RTAs. Similar trend was also observed in other countries celebrating Ramadan [12-15]. The socioeconomic consequences of road traffic injuries include costs of prolonged medical care, loss of the family breadwinner and loss of income due to disability; together these factors often push families into poverty [30].

Conclusion

The study has described trends of RTAs managed by emergency department of hospitals in Karachi. Hospital of Karachi experienced a higher burden of RTAs emergencies in the month of Ramadan 2014 as compared with the preceding months of the year. This increase was mostly concentrated among younger ages range from 16-25 years of age. Injuries in city of Karachi are an important public health problem and contribute to major bulk of Emergency facilities. These accidents and the resultant injuries have considerable physical and socioeconomic impacts; therefore, this issue needs to be addressed. By putting into effect laws that enforce road safety measures and helmet usage can prevent these injuries.

References

1. Global plan for the decade of action for road safety 2011–2012. Geneva, World Health Organization, 2012.
2. Global status report on road safety: time for action. Geneva, World Health Organization, 2009
3. Waseem H et al. Epidemiology of major incidents: an EMS study from Pakistan. International Journal of Emergency Medicine, 2011, 4:48.
4. Bhatti JA et al. Differences in police, ambulance and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan. BMC Research Notes, 2011, 4:75.
5. Ghaffar A, Hyder AA, Masud TI. The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan. Public Health, 2004, 118:211–217.
6. Fatmi Z, Hadden WC, Razzak JA. Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990–94. BMC Public Health, 2007, 7:152.
7. Ahmed A. Road safety in Pakistan Islamabad. Islamabad, National Road Safety Secretariat, 2007.
8. Raja IA, Vohra AH, Ahmed M. Neurotrauma in Pakistan. World Journal of Surgery, 2001, 25:1230–1237.
9. The characteristics of fatal crashes during the Christmas/New Year holiday period. ATSB Research and Analysis Report, Road Safety. Canberra, Australian Transport Safety Bureau, 2006.
10. Digests of road transport and road accident statistics – 2003. Mauritius, Central Statistics Office, 2004.
11. Cejun L, Chou LC, Dennis U. Trend and pattern analysis of highway crash fatality by month and day. Washington DC, National Center for Statistics and Analysis, 2005.
12. Ramadan advisory. Karachi, Jinnah Postgraduate Medical Centre, Road Traffic Injury Research & Prevention Centre, 2010.
13. Road accidents in Bahrain “on the rise” (http://www.tradearabia.com/news/MTR_184998.html, accessed 25 November 2011).
14. Dajani H. Ramadan shifts put extra strain on roads (http:// www.thenational.ae/news/uae-news/ramadan-shifts-putextra-strain-on-roads, accessed 25 November 2011).
15. Shanks NJ, Ansari M, Al-Kalai D. Road traffic accidents in Saudi Arabia. Public Health, 1994, 108:27–34.
16. Tahir N et al. Road traffic crashes managed by Rescue 1122 in Lahore, Pakistan. International Journal of Injury Control and Safety Promotion, 2012, 19:347–350.
17. Masud U, Shehzad MA, Saeed A. Epidemiology of fatalities in road traffic accidents in Faisalabad during 2008–2009 – an autopsy study. APMC, 2011, 5:1–4.
18. Babar M, Muhammad HK, Mohammad WK. Frequency of helmet use among motorcycle riders in Rawalpindi. Professional Medical Journal, 2007, 14:663–668.
19. Sreedharan J, Muttappillymyalil J, Divakaran B. Determinants of safety helmet use among motorcyclists in Kerala. Journal of Injury and Violence Research, 2010, 2:49–54.
20. Gururaj G. Road traffic deaths, injuries and disabilities in India: current scenario. National Medical Journal of India, 2008, 21:14–20.
21. Singh YN, Bairagi KK, Das KC. An epidemiological study of road traffic accident victims in medicolegal autopsies. Journal of Indian Academy of Forensic Medicine, 2005, 27:166–169.
22. Pathak A, Desania NL, Verma R. Profile of road traffic accidents and head injury in Jaipur (Rajasthan). Journal of Indian Academy of Forensic Medicine, 2008, 30:6–9.
23. Hyder AA, H Waters, T Phillips. Exploring the economics of motorcycle helmet laws – implications for low and middle-income countries. Asia-Pacific Journal of Public Health, 2007, 19:16.
24. Akbari ME, Naghavi M, Soori H. Epidemiology of deaths from injuries in the Islamic Republic of Iran. Eastern Mediterranean Health Journal, 2006, 12:382–390.
25. Ibrahim MKA, Sukardi A. Use of instrumented motorcycle to study riding behaviors of Malaysian novice motorcyclists. European Journal of Scientific Research, 2011, 49:625–633.
26. Chang HL, Yeh TH. Motorcyclist accident involvement by age, gender, and risky behaviors in Taipei, Taiwan. Transportation Research, 2007, 10:109–122.
27. Savolainen P, Mannering F. Probabilistic models of motorcyclists’ injury severities in single and multi-vehicle crashes. Accident Analysis and Prevention, 2007, 39:955–963.
28. Yau K. Risk factors affecting the severity of single vehicle traffic accidents in Hong Kong. Accident Analysis and Prevention, 2003, 36:333–340.
29. Zambon F, Hasselberg M. Factors affecting the severity of injuries among young motorcyclists – a Swedish nationwide cohort study. Traffic Injury Prevention, 2006, 7:143–149.
30. Khan MH et al. Road traffic accidents; study of risk factors. Professional Medical Journal, 2007, 14:323–327.

How to Cite this article: Kumar R, Muzzammil M, Minhas MS, Bhatti A, Kumar V, Syed J. Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan . Trauma International May – Aug 2016;2(2):40-43.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

Full Sized Blog Element (Big Preview Pic)

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1]

Abstract

Introduction

Implant

Conclusions

(Abstract) (Full Text HTML) (Download PDF)

Road Traffic Accidents :Age and Gender distribution and impact of Religious Month and Holidays (Ramadan and Eid) on frequency of RTAs in Karachi Pakistan

Author: Ranjeet Kumar [1], Muhammad Muzzammil [1], Muhammed Saeed Minhas [1], Anisuddin Bhatti [1], Vinod Kumar [1], Syed Jahanzeb [1].

Abstract

Introduction

Methods

Results

Discussion

Conclusion

References

(Abstract) (Full Text HTML) (Download PDF)

Contact

Important Links

LICENSE