Blunt thoracic trauma

The restructuring of emergency healthcare services has led to more blunt thoracic trauma being treated by a multidisciplinary team, including general, orthopaedic and trauma surgeons, often without immediate access to a thoracic surgeon. Having a critical mass of injured patients in a central location, it has been possible to bring expertise from other areas of intensive care, radiology and surgery and apply new technology and techniques to the trauma patient. We now see the regular use of endovascular stenting and embolization reducing the need for urgent surgery on unstable patients and the increasing use of extracorporeal membranous oxygenation (ECMO) to salvage patients with acute respiratory distress syndrome. A more liberal use of video-assisted thoracic surgery (thoracoscopic) decortication and chest wall fixation both reduce ICU requirements and shorten hospital stay. It is hoped that these improvements in the hospital management of chest injuries will not only improve survival, but that the reduction in the late sequelae of chronic pain and loss of stamina will translate into improved return-to-work rates.     

Temporary and definitive external fixation of war injuries: use of a French dedicated fixator

Purpose

External fixation is the recommended stabilization method for both open and closed fractures of long bones in forward surgical hospitals. Specific combat surgical tactics are best performed using dedicated external fixators. The Percy Fx© (Biomet) fixator was developed for this reason by the French Army Medical Service, and has been used in various theatres of operations for more than ten years.

Methods

The tactics of Percy Fx© (Biomet) fixator use were analysed in two different situations: for the treatment of French soldiers wounded on several battlefields and then evacuated to France and for the management of local nationals in forward medical treatment facilities in Afghanistan and Chad.

Results

Overall 48 externals fixators were implanted on 37 French casualties; 28 frames were temporary and converted to definitive rigid frames or internal fixation after medical evacuation. The 77 Afghan patients totalled 85 external fixators, including 13 temporary frames applied in Forward Surgical Teams (FSTs) prior to their arrival at the Kabul combat support hospital. All of the 47 Chadian patients were treated in a FST with primary definitive frames because of delayed surgical management and absence of higher level of care in Chad.

Conclusion

Temporary frames were mostly used for French soldiers to facilitate strategic air medical evacuation following trauma damage control orthopaedic principles. Definitive rigid frames permitted achieving treatment of all types of war extremity injuries, even in poor conditions.     

An evaluation of prophylactic treatments to prevent post traumatic joint stiffness

Arthrofibrosis is a major obstacle to restoring joint function after trauma. The objective of this study was to evaluate montelukast, forskolin, and triamcinolone as possible means of prophylaxis against the formation of arthrofibrosis. Forty‐eight rats underwent surgical knee trauma with post‐operative immobilization in full flexion. The treatment groups were: control (CTL), oral montelukast (3.75 mg/kg/day) (MLK), intra‐articular forskolin injections (0.6 mg/kg) (FSK), and intra‐articular triamcinolone injections (0.68 mg/kg) (STR). Rats were sacrificed after 14 days and femorotibial contracture angles were measured with the posterior capsule intact and with the posterior capsule cut. A 0.015Nm extension moment was applied to the knee. All treatment groups had significant reductions in contracture angle compared to the control. Mean contractures with the posterior capsule intact were 32°(CTL), 20° (MLK), 22° (FSK), and 7° (STR). Contractures with the posterior capsule cut were 28° (CTL), 19° (MLK), 20° (FSK), and 5° (STR). The STR group was significantly better than FSK and MLK. Triamcinolone injections provided dramatic reductions in stiffness. Both forskolin and montelukast provided significant, though lesser, reductions in stiffness. While the triamcinolone contracture angles were significantly better, the novel treatments of forskolin and montelukast provided encouraging results and should be studied further. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1520–1524, 2014.     

Biomechanical investigation of naso-orbitoethmoid trauma by finite element analysis

Naso-orbitoethmoid fractures account for 5% of all facial fractures. We used data derived from a white 34-year-old man to make a transient dynamic finite element model, which consisted of about 740 000 elements, to simulate fist-like impacts to this anatomically complex area. Finite element analysis showed a pattern of von Mises stresses beyond the yield criterion of bone that corresponded with fractures commonly seen clinically. Finite element models can be used to simulate injuries to the human skull, and provide information about the pathogenesis of different types of fracture.     

Applications of basic fibroblastic growth factor (FGF‐2, bFGF) in dentistry

Recent developments in research have been based on the maintenance and regeneration of natural organs and tissues; among such developments is the use of growth factors (GFs). The use of basic fibroblastic growth factors (bFGF) may be indicated in different disciplines of dentistry such as periodontics and dental traumatology. These cells' ability to induce proliferation and differentiation of cells may make GFs a useful source for the development of natural structures. This mini‐review will discuss how bFGF can be beneficial to dentistry in relation to 1) re‐implantation/autotransplantation of avulsed teeth and 2) periodontal regeneration.