Surgical management of peripheral artery pseudoaneurysm following orthopedic trauma: a report of 14 cases.

PURPOSE: Purpose of this study was to report the etiology, diagnosis, surgical management, and outcome of pseudoaneurysm associated with orthopedic trauma. METHODS: A retrospective review was conducted of all patients presenting to a Level 1 trauma center between 2013 and 2019. Clinical records were reviewed for the mechanism of primary injury, associated fracture pattern, time of presentation, site of involvement, etiology of the pseudoaneurysm, diagnosis, management, and complications. We identified 14 patients with pseudoaneurysm of peripheral arteries following orthopedic trauma. RESULTS: The mean interval between primary injury and the manifestation of clinical symptoms was 88.5 days (range, 16-304 days). There were 3 upper limb injuries and 11 lower limb injuries. The presenting symptoms were pain associated with excessive extremity swelling in most of the patients. A significant drop in hemoglobin (mean fall- 2.9 g/dL) was noted in nine patients. Most common artery involved was the superficial branch of femoral artery and posterior tibial artery followed by the brachial artery. Fractured bone spike was the cause of injury in eight patients and iatrogenic injury in six patients. Diagnosis was confirmed by CT angiography with duplex scan in eight patients, duplex scan alone in one patient, MRI along with duplex scan in one patient. The remaining four patients were diagnosed intraoperatively. Excision of the pseudoaneurysm and ligation of the involved minor arteries was done in eight patients. Surgical repair of the major artery with critical vascular injury was done in six patients. One patient underwent secondary amputation following the anastomotic blowout. CONCLUSION: Early diagnosis of pseudoaneurysm requires knowledge and a high index of suspicion. Surgical reconstruction of major arteries should always be done and ligation of major vessels can lead to catastrophes. Excision of pseudoaneurysm can be done when minor arteries are involved with the presence of good collateral circulation. LEVEL OF STUDY: Level IV Study.

Current updates in management of extremity injuries in polytrauma.

Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from "Early Total Care" to "Damage Control Orthopedics." While most of these algorithms were tailored to the philosophy of "life before limb," the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, "Early Appropriate Care" of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms "Polytrauma," "Multiple Trauma," and "Fractures." This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.

Management of Tibial Shaft Fractures Distal to TKA Prosthesis by Intramedullary Nail: A Report of Three Cases.

INTRODUCTION: Diaphyseal tibial fractures distal to a well-fixed tibial component although rare present a significant challenge and optimal treatment remains controversial. Displaced periprosthetic tibial shaft fractures are ideally treated with open reduction internal fixation with plate osteosynthesis. However, this treatment method is associated with weight-bearing restrictions, which can be difficult for elderly patients with multiple comorbidities and balance impairment. We present our experience of internal fixation with an intramedullary nail that uses an inferior entry point, standard intramedullary tibial nail, and conventional instrumentation. MATERIALS AND METHODS: Between 2017 and 2018, three patients with acute tibial shaft fractures distal to a TKA (Felix Type 3A) were treated with an intramedullary nail. Preoperative planning involved assessing proximal tibia to ensure adequate room for implant and instrumentation. The average patient age was 66.3 years (range 59-72 years) and all patients were males. All the patients sustained fractures of distal tibial and fibula diaphysis, after a road traffic accident. There were no complications intraoperatively, and all procedures were completed uneventfully. One patient underwent additional fixation of the fibula. RESULTS: All patients achieved a radiological fracture union after an average of 20.6 weeks. There were no fixation failures, or nonunions postoperatively. There were no new symptoms relative to the TKA that could be attributed to the tibial nailing procedure. CONCLUSION: We recommend that this technique can be used primarily for this fracture pattern distal to a TKA, provided there is adequate space to accommodate the nail and instrumentation proximally anterior to the tibial tray.

Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims.

The purpose of the study was to assess the relationship between trauma-related sleep disturbance and physical health symptoms in treatment-seeking female rape victims. A total of 167 participants were assessed for PTSD symptoms, depression, sleep disturbance, and frequency of self-reported health symptoms. Results demonstrated that trauma-related sleep disturbance predicted unique variance in physical health symptoms after other PTSD and depression symptoms were controlled. The findings suggest that trauma-related sleep disturbance is one potential factor contributing to physical health symptoms in rape victims with PTSD.

Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder.

The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD.

Gender differences in risk factors for trauma exposure and post-traumatic stress disorder among inner-city drug abusers in and out of treatment.

Over the past two decades there has been a growing awareness of the comorbidity between post-traumatic stress disorder (PTSD) and substance use disorders in the general population. The purpose of these analyses was to examine, in a population of drug users, the role of gender in (1) predicting the nature of the traumatic event and PTSD symptoms, (2) patterns of substance use disorders in relation to trauma exposure and PTSD symptoms, (3) comorbidity of other psychiatric disorders with trauma exposure and PTSD, and (4) the temporal association of substance use disorder, exposure to trauma, and PTSD. Drug abusers (n = 464) were interviewed using the Diagnostic Interview Schedule for DSM-III-R (DIS) and the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Although more women than men met criteria for DSM-III-R PTSD, there were no gender differences on endorsement for a traumatic event. Adult antisocial behavior, affective disorder, schizophrenia, other anxiety disorder and polysubstance use predicted exposure to an event, whereas, only schizophrenia and other anxiety disorder predicted PTSD. In men, drug use preceded the exposure to an event, while in women, the onset age for both drug use and exposure to an event were nearly identical. This work suggests implications for gender-based education and prevention interventions.

Prior interpersonal trauma: the contribution to current PTSD symptoms in female rape victims.

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma.

Brief hypnosis substitutes for alprazolam use in college students: transient experiences and quantitative EEG responses.

We sought to determine: 1) whether a simple hypnotic induction with an alprazolam experience derived suggestion could recreate the subjective effects of alprazolam (Xanax), 2) whether the effects of alprazolam are greater than the effects of hypnosis plus this suggestion, and 3) whether the effects of hypnosis plus this suggestion were greater than the relaxation effects produced by hypnosis alone. High and low hypnotizable student volunteer subjects (Ss) ingested 1 mg of alprazolam. A hypnotic suggestion was developed on the basis of their reported reactions to alprazolam. Four days later the same Ss were exposed to hypnosis only and hypnosis plus the alprazolam experience based suggestion conditions in counterbalanced order. Ss exposed to the hypnosis plus suggestion condition demonstrated greater levels of relaxation as measured by the tension-anxiety scale of the Profile of Mood States (POMS) (Eichman & Umstead, 1971) than in the alprazolam condition or the hypnosis only condition. High hypnotizables showed significantly greater levels of relaxation than the low hypnotizables in each of the three conditions (hypnosis plus suggestion, hypnosis only, alprazolam only). EEG data showed frontal and occipital sites were specifically involved in both the alprazolam and the hypnotic suggestion conditions. The findings indicate a basis for the use of hypnosis as a substitute for sedative drug use. Limitations and implications for clinicians are discussed.

Expectations and motives for alcohol use in a psychiatric outpatient population.

The purpose of the study was to assess alcohol expectancies and motives of psychiatric outpatients with and without comorbid current or lifetime substance use disorders. Seventy-five psychiatric outpatients with diagnoses of mood disorders, anxiety disorders, and substance use disorders were administered the Alcohol Effect Expectancy Questionnaire-Abridged Version and the Drinking Motives Measure. Results demonstrated that the internal reliabilities for the two scales were comparable with those reported for these measures in the general population. Psychiatric outpatients with a history of comorbid substance use disorders reported greater expectancies and motives for using alcohol than did patients with no such history. In addition patients with comorbid alcohol and drug use disorders, and only comorbid alcohol use disorder, showed significantly greater expectancies and motives for alcohol use than patients with only comorbid drug use disorders and patients with no history of comorbid substance use disorder. We discuss the implications of the findings for role of expectancies and motives in the maintenance and treatment of substance abuse in psychiatric patients.

Emotion recognition and social competence in chronic schizophrenia.

This study evaluated (a) whether chronic, medicated schizophrenia patients show deficits in emotion recognition compared to nonpatients, and (b) whether deficits in emotion recognition are related to poorer social competence. Two emotion recognition tests developed by S. L. Kerr and J. M. Neale (1993) and Benton's Test of Facial Recognition (A. Benton, M. VanAllen, K. Hamsher, & H. Levin, 1978) were given to patients with chronic schizophrenia and nonpatient controls. Patients' social skills, social adjustment, and symptomatology were assessed. Like Kerr and Neale's unmedicated patients, these patients performed worse than controls on both emotion recognition tests and the control test. For patients, facial perception was related to the chronicity of illness and social competence. Chronicity of illness may contribute to face perception deficits in schizophrenia, which may affect social competence.

Relations between social skills and ward behavior in chronic schizophrenia.

The relationship between social skills and ward behavior among chronic schizophrenia patients was investigated. Twenty-eight inpatients participated in an unstructured role play test and were rated by staff members on a number of indices of ward behavior (e.g., social interactions, inappropriate behavior). Overall, there was a relationship between social skill on the role play and social behavior on the ward. Speech clarity was the social skill most strongly related to ward behavior, even when controlling for symptomatology. However, several other social skill variables (e.g., gaze, affect) were not related to social adjustment. The results are discussed in terms of the validity of social skill assessments in patients with chronic schizophrenia, and their implications for psychosocial treatment of this population.

Expectations and motives for substance use in schizophrenia.

This study examined the internal reliability of standardized measures of substance use expectancies and motives in a schizophrenia population (n = 70) and the relationship of these expectancies and motives to alcohol and drug use disorders. Internal reliabilities were uniformly high for the subscales of the expectancy and motive measures. Analyses of the relationship between substance use disorders and expectancies revealed strong substance-specific expectations. Alcohol expectancies were related to alcohol disorders but not to drug disorders; cocaine expectancies were related to drug but not to alcohol disorders; and marijuana expectancies were more strongly related to drug than to alcohol use disorders. In contrast, motives were related to substance use disorders, and self-reported substance use problems were related to expectancies and motives in a non-specific manner. These results suggest that expectancy and motive questionnaires developed for the primary substance abuse population may be valid for psychiatric populations. Research on motives and expectancies may help to clarify the functions of substance abuse in persons with schizophrenia.