Jornal de Trauma e Tratamento

Background: Humeral fractures can occur alone or as part of associated injuries in polytrauma. We aim to document the pattern and management of these fractures in our sub-region.
Patients and Method: This was a retrospective study of all cases of humeral fractures that presented at our outpatient and emergency departments from January 2012 to December 2014. Information obtained includes age, sex, mechanism and pattern of injury, treatment offered and outcome. Level of significance was < 0.05
Results: A total of eighty cases were seen with a M: F ratio of 4.3:1. Thirty-three percent of patients were between 31-40 year and the left humerus was affected in 51.3%. Road traffic accident was the commonest mechanism in 71.3%. Eighty-five percent of cases were closed fractures and diaphyseal fractures constituted 56.3%. Oblique fracture pattern was the commonest in 42.5% followed by transverse in 23.8%. There were associated injuries in 52.5% of cases. Eighty- four per cent of patients presented within 72 hours of injury while 11.3% of patient had prior treatment by Traditional bone setters (TBS). Complications at presentation in those with prior TBS intervention was statistically significant (P=0.005). Treatment offered were cast splintage in 57.5%, open reduction and internal fixation in 17.5%. Amputation was done in 5.0% of cases. Wound sepsis (5.0%), elbow stiffness (2.5%), chronic osteomyelitis (2.5%) were the encountered post intervention complications.
Conclusion: Fractures involving the humerus are mainly diaphyseal and cast splintage is the commonest mode of management in our sub-region.

Acetabular fractures present with a bimodal distribution, as is often associated with traumatic injuries presenting to trauma and orthopaedic surgeons. It is an injury that mandates a multi- disciplinary team approach as it is associated with injuries to another organ system and/or the lower extremities. The implementation of Advanced Trauma and Life Support (ATLS) principals has led to significant improvements and standardisation of how this injury is managed outside of the hospital setting and emergency management however controversies exist regarding the definitive treatment of this condition. A literature review of this interesting and common place fracture is presented whilst highlighting the areas of debate regarding its further management.

Introduction: Dislocation of the knee joint and fractures about the proximal tibia are extremely rare occurrences in the paediatric age groups. Based on the Salter and Harris classification system, we present a case of Type 1 fracture of the proximal tibia with complete separation of the epiphysis. The case also highlights the presence of other concomitant injuries that accompany the trauma around the knee.
Case Report: An 8 year old male child was brought to the casualty of the hospital after sustaining injury to the knee while playing soccer at school. He was struck from front by another kid and immediately fell with extreme pain in the knee. He presented to us after a delay of 2 hours post injury. On arrival there was gross swelling of the knee joint and also the leg involving the foot. The distal pulsations were feeble but palpable. Toe movements were limited. Immediate radiological assessment revealed a fracture involving the proximal tibia. Patient was found to have signs of impending compartment syndrome. Emergency surgery was taken up in presence of a vascular surgeon, the fracture reduced, vascularity preserved and fasciotomy done. Child was discharged after a stay of 20 days with good range of movements at the knee joint.
Conclusion: The rarity of the proximal knee injuries, combined with neuro vascular damage render this area a perilous zone in paediatric orthopaedics. However prompt intervention leads to good functional recovery and early mobilization.

Objective: To determine the demographics, risk factors, patterns of injuries sustained from off road motor vehicles in rural NSW.
Design: A retrospective review.
Setting: Dubbo Base Hospital is a major referral base hospital for Western NSW. Participants: All patients admitted to Dubbo Base Hospital with off-road motor vehicle injuries in between years 2009-2011.
Main outcome measures: Demographics, referral areas, pattern of injuries sustained from off road motor vehicle accidents.
Results: There were total of 57 cases, with 53 being males. Average age for the patient was 13.7. There were 9 quadbike accidents, and 48 off road dirtbike accidents. For quadbike accidents, mechanism of injuries were: collision(5), rollovers (3), fall (1). Four out of nine quadbike accident patients were wearing a helmet. With off road motorbike (dirtbike) accidents, 17 were from motorcross jumps, and 31 were farming accidents. Farming accidents comprised of 19 falls and 12 collisions. Of the 17 involved in motorcross jump related accident, 12 were wearing safety gears. On average, they were travelling at much higher speed, with average of 50 km/hr, and highest of 80 km/hr. The most common injuries were soft tissue injuries and peripheral long bone fractures, however more severe injuries were noted with motocross jump related injuries.
Discussion/Conclusion: This study found the vast majority of injuries from off road motor vehicles in rural Australia occur in children. It is of concern that there are currently no enforceable road regulations for off-road motor vehicle use on privately owned properties. There needs to be better education of the younger drivers as well as enforceable regulations to allow safe use of the off road motor vehicles.

Facial fractures are common injuries that frequently necessitate plastic surgery intervention, and motor vehicle accidents are among the most common etiologies of facial fractures. Current passenger restraint devices have consistently proven to decrease the rates of facial fractures in MVCs, but improvements should be pursued to further reduce fracture rates and the severity of maxillofacial injuries sustained in these accidents. Innovations in plate fixation systems, imaging technology, and virtual surgical planning contribute to the dynamic landscape of facial fracture management. Well-designed prospective and controlled studies of these technologies are necessary in order to establish rigorous, evidence-based guidelines.

Background: According to the published literature, Ipsilateral displaced clavicle and scapular neck fractures, also called floating shoulder injury (FSI), can be managed conservatively or surgically; however, the therapeutic option for this rare injury remains controversial.
Case Description: We presented a 18-year-old male patient who suffered FSI of the right shoulder. A threedimensional (3D) impression of the injured shoulder joint was obtained to plan the operation. The patient was operated by open reduction and plate internal fixation (ORIF) of the fractures with the aid of 3-D printing model.
Literature Review: Our literature review included various treatments associated with FSI. We identified that no previous reports of floating shoulders treated by ORIF with the aid of 3-D printing technique.
Purposes and Clinical Relevance: This report illustrates the practicability of 3-D printing technique in surgical treatment, which could enhance the surgeon’s understanding the trauma of FSI, resulting in increased surgery precision and decreased trauma.