Acute Gastrointestinal Injury in Polytrauma: Special Attention to Elderly Patients.

Background: Acute gastrointestinal injury (AGI) has been documented in critically ill patients, yet there remains a dearth of knowledge regarding its occurrence, predisposing factors, and outcomes in elderly polytrauma patients, a significant but overlooked population. This study aims to examine the frequency, risk factors, and clinical implications of AGI in elderly polytrauma patients. Methods: A retrospective, observational, multicenter study was carried out in two Level I trauma centers, encompassing a cohort of 1054 polytrauma patients from July 2020 to April 2022. Results: A total of 965 consecutive polytrauma patients were recruited who were divided into youth group (n=746) and elderly group (n=219). 73.5% of elderly patients after polytrauma were accompanied by AGI. An increasing ISS (OR=2.957, 95%CI: 1.285-7.714), SI (OR=2.861, 95%CI: 1.372-5.823), serum lactate (OR=2.547, 95%CI: 1.254-5.028), IL-6 (OR=1.771, 95%CI: 1.145-8.768), APTT (OR=1.462, 95%CI: 1.364-4.254) and a decreasing GCS (OR=0.325, 95%CI: 0.116-0.906) were each associated with an increasing risk of AGI in elderly polytrauma patients. Elderly polytrauma patients with AGI were presented relatively high 28-day mortality (40.4%) and super high 60-day mortality (61.2%) compared with elderly group without AGI and youth group with AGI. The area under the curve for predicting 28-day mortality in elderly polytrauma patients with AGI was 0.93 for AGI-III,IV with 96% sensitivity and 87% specificity. Conclusion: Elderly patients have a higher incidence and a worse prognosis of AGI after polytrauma. ISS, GCS, SI, serum lactate, IL-6, and APTT are identified as reliable prognostic markers to distinguish the AGI and N-AGI in elderly polytrauma patients. AGI-III,IV was the independent predictor of mortality in elderly polytrauma patients with AGI.

Case series report: use of vibroacoustic pulmonary therapy in patients with thoracic trauma complicated by acute respiratory failure.

Chest injury is often accompanied by polytrauma and is complicated by respiratory failure. This article presents a series of cases with verified acute respiratory failure in patients with chest injury, where vibroacoustic pulmonary therapy was used in complex treatment. Dynamic X-rays and respiratory drive indicators reflected the effect of the use of vibroacoustic lung therapy. Early diagnosis of respiratory disorders and complex therapy using vibroacoustic pulmonary therapy can improve results. As a result, the time spent in the hospital and in the intensive care unit is reduced, and the frequency of adverse outcomes is reduced.

Heterotopic Ossifications Following Intramedullary Stabilization of Femoral Fractures in Polytraumatized Patients.

INTRODUCTION: Heterotopic ossifications (HOs) are a well-known complication following total hip arthroplasty. Yet only little is known about the development of HOs following a femoral fracture and intramedullary stabilization in polytraumatized patients. Thus, the present study aimed to investigate whether the development of HOs is being observed more frequently in patients suffering polytrauma compared to those with single-extremity trauma. MATERIALS AND METHODS: The retrospective outcome study was conducted at our level I trauma center. All patients admitted from 2010 to 2020 were included if they (1) presented with multiple injuries (≥2 body regions), (2) had an Injury Severity Score ≥16, (3) suffered a femoral fracture, and (4) were treated with intramedullary stabilization. Furthermore, a control group was established to match the polytrauma group (sex, age), who were suffering from single-extremity trauma (femoral fracture) which was treated with intramedullary stabilization. Subsequently, X-rays of the hip were performed and evaluated for up to one-year post-trauma. RESULTS: Our study group consisted of 36 patients in total (91.7% male; mean age 39.4 ± 17.4 years, range: 18-82 years). The polytrauma (PT) group included 12 patients (mean age 39.5 years, median ISS 28), whereas the control group (single-extremity-trauma) included 24 patients (mean age 39.3 years). We documented HOs in nine (75%) patients in the PT group vs. five (20.8%) patients in the single-extremity group (p = 0.03). CONCLUSION: In this study, we were able to demonstrate that heterotopic ossifications are being observed significantly more frequently in patients suffering from polytrauma in comparison to patients with single-extremity trauma following intramedullary stabilization after a femoral fracture.

Multiple fractures of the femur: Case report, literature review, and proposal for a shared algorithm of treatment.

Multiple fractures of the femur, defined for the purposes of this study as the association of three or more non-contiguous fractures on the same bone segment, is an exceedingly rare condition with an unknown incidence in the literature. A limited number of studies, mainly consisting of case reports or small case series, have addressed this topic, and no shared consensus or guidelines exist on what the ideal timing and sequence of multiple fracture fixation is. The present paper reports the clinical case of a 36 years old man who sustained a blunt chest injury, a non-concussive head injury, a displaced intracapsular fracture of the left femur (AO 31B2), a left diaphyseal multifragmentary fracture (AO 32B3), a supradiacondylar fracture of the distal end of the left femur (AO 33C1.1), a Hoffa fracture of the lateral left femoral condyle (AO 33B3.2 f), and a multifragmentary fracture of the left patella with bone loss (AO 34C3) due to a vehicular high-energy trauma. The patient was surgically treated by open reduction and internal fixation according to a proposed algorithm of treatment and reported excellent clinical and radiological outcomes at 32 months follow-up. The primary aim of this study is to describe our experience in the treatment of such complex fractures, by presenting our clinical and radiological results, and to propose a treatment algorithm. The secondary aim is to provide a comprehensive review of the literature on this topic.

Pulmonary miRNA expression after polytrauma depends on the surgical invasiveness and displays an anti-inflammatory pattern by the combined inhibition of C5 and CD14.

Background: Respiratory failure can be a severe complication after polytrauma. Extensive systemic inflammation due to surgical interventions, as well as exacerbated post-traumatic immune responses influence the occurrence and progression of respiratory failure. This study investigated the effect of different surgical treatment modalities as well as combined inhibition of the complement component C5 and the toll-like receptor molecule CD14 (C5/CD14 inhibition) on the pulmonary microRNA (miRNA) signature after polytrauma, using a translational porcine polytrauma model. Methods: After induction of general anesthesia, animals were subjected to polytrauma, consisting of blunt chest trauma, bilateral femur fractures, hemorrhagic shock, and liver laceration. One sham group (n=6) and three treatment groups were defined; Early Total Care (ETC, n=8), Damage Control Orthopedics (DCO, n=8), and ETC + C5/CD14 inhibition (n=4). Animals were medically and operatively stabilized, and treated in an ICU setting for 72 h. Lung tissue was sampled, miRNAs were isolated, transcribed, and pooled for qPCR array analyses, followed by validation in the individual animal population. Lastly, mRNA target prediction was performed followed by functional enrichment analyses. Results: The miRNA arrays identified six significantly deregulated miRNAs in lung tissue. In the DCO group, miR-129, miR-192, miR-194, miR-382, and miR-503 were significantly upregulated compared to the ETC group. The miRNA expression profiles in the ETC + C5/CD14 inhibition group approximated those of the DCO group. Bioinformatic analysis revealed mRNA targets and signaling pathways related to alveolar edema, pulmonary fibrosis, inflammation response, and leukocytes recruitment. Collectively, the DCO group, as well as the ETC + C5/CD14 inhibition group, revealed more anti-inflammatory and regenerative miRNA expression profiles. Conclusion: This study showed that reduced surgical invasiveness and combining ETC with C5/CD14 inhibition can contribute to the reduction of pulmonary complications.

TBI related death has become the new epidemic in polytrauma: a 10-year prospective cohort analysis in severely injured patients.

INTRODUCTION: Advances in trauma care have attributed to a decrease in mortality and change in cause of death. Consequently, exsanguination and traumatic brain injury (TBI) have become the most common causes of death. Exsanguination decreased by early hemorrhage control strategies, whereas TBI has become a global health problem. The aim of this study was to investigate trends in injury severity,physiology, treatment and mortality in the last decade. METHODS: In 2014, a prospective cohort study was started including consecutive severely injured trauma patients > 15 years admitted to a Level-1 Trauma Center ICU. Demographics, physiology, resuscitation, and outcome parameters were prospectively collected. RESULTS: Five hundred and seventy-eight severely injured patients with predominantly blunt injuries (94%) were included. Seventy-two percent were male with a median age of 46 (28-61) years, and ISS of 29 (22-38). Overall mortality rate was 18% (106/578) with TBI (66%, 70/106) being the largest cause of death. Less than 1% (5/578) died of exsanguination. Trend analysis of the 10-year period revealed similar mortality rates despite an ISS increase in the last 2 years. No significant differences in demographics,and physiology in ED were noted. Resuscitation strategy changed to less crystalloids and more FFP. Risk factors for mortality were age, brain injury severity, base deficit, hypoxia, and crystalloid resuscitation. DISCUSSION: TBI was the single largest cause of death in severely injured patients in the last decade. With an aging population TBI will increase and become the next epidemic in trauma. Future research should focus on brain injury prevention and decreasing the inflammatory response in brain tissue causing secondary damage, as was previously done in other parts of the body.

Ipsilateral Floating Hip and Floating Knee with Multiple Fractures - A Case Report.

Introduction: Floating hip and floating knee are high-velocity injuries associated with high mortality and morbidity. The occurrence of both floating hip and floating knee in the same limb is rare and requires proper resuscitation and orthopedic care for the management and for providing a functional limb to the patient. Case Report: A 32-year-old male presented with a history of road traffic accident and sustained ipsilateral acetabulum anterior column fracture, sacroiliac joint disruption, double segmental fracture of femur, and segmental fracture of tibia (left side). The patient also sustained head injury and abdominal injuries. The patient underwent a three-staged fixation of the fractures. External fixation of all the fractures was done as an emergency procedure. After the general condition of the patient improved, the acetabular injuries were managed surgically with fixation of the tibia in the same setting. The femur fracture was fixed in the end with a long proximal femur nail. The patient underwent adequate rehabilitation with return to full weight bearing at 4 months. All fractures healed at 6 months. At 18 months, the patient had no limitation of movements and his lower extremity functional score was 73/80 (91.3%). Conclusion: Ipsilateral floating hip and floating knee are rare injuries. With early fixation and mobilization, we can ensure fracture union with better functional outcomes.

Epidemiology of postinjury multiple organ failure: a prospective multicenter observational study.

PURPOSE: Postinjury multiple organ failure (MOF) is the sequela to the disease of polytrauma. We aimed to describe the contemporary population-based epidemiology of MOF within a mature trauma system, to analyse the time taken for MOF to develop, and to evaluate the temporal patterns and contributions of the individual constituent organ failures. METHODS: Prospective observational study conducted across five Level-1 trauma centers in New South Wales, Australia. Trauma patients at-risk of MOF (Denver > 3 from 48 h post-admission), aged > 16 years, ISS > 15, and who stayed in ICU for ≥ 48 h were eligible for inclusion. RESULTS: From May 2018-February 2021, 600 at-risk polytrauma patients were prospectively enrolled (mean(SD)age = 49(21)years, males = 453/600(76%),median(IQR)ISS = 26(20,34)). MOF incidence was 136/600(23%) among at-risk patients, 142/6248(2%) among major trauma patients (ISS > 12 per Australian definition), and 0.8/100,000 in the general population. The mortality rate was 55/600(11%) in the overall study population, and 34/136(25%) in MOF patients. 82/136(60%) of MOF patients developed MOF on day-3. No patients developed MOF after day-13. Among MOF patients, 60/136(44%) had cardiac failures (mortality = 37%), 39/136(29%) had respiratory failures (mortality = 23%), 24/136(18%) had renal failures (mortality = 63%), and 12/136(9%) had hepatic failures (mortality = 50%). CONCLUSION: Although a rare syndrome in the general population, MOF occurred in 23% of the most severely injured polytrauma patients. When compared to previous risk-matched cohorts, MOF become more common, but not more lethal, despite a decade older cohort. The heart has superseded the lungs as the most common organ to fail. Cardiac and respiratory failures occurred earlier and were associated with lower mortality than renal and hepatic failures.

Novel application of latent class analysis to outcome assessment in traumatic brain injury with multiple injury subtypes or poly-TBI.

OBJECTIVE: The aim of this study was to stratify poly-traumatic brain injury (poly-TBI) patterns into discrete classes and to determine the association of these classes with mortality and withdrawal of life-sustaining treatment (WLST). METHODS: The authors performed a single-center retrospective review of their institutional trauma registry from 2018 to 2020 to identify patients with traumatic brain injury (TBI). Patients were included if they had moderate to severe TBI, defined as Glasgow Coma Scale score ≤ 12 and Abbreviated Injury Scale (AIS) head score ≥ 3, and the presence of more than one TBI subtype. TBI subtypes were defined as subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and epidural hemorrhage (EDH). Latent class analysis was used to identify patient classes based on TBI subtypes and Rotterdam CT (RCT) scores. The authors then evaluated class membership in relation to categorical outcomes of in-hospital mortality and WLST by using Lanza et al.'s method. RESULTS: A total of 125 patients met inclusion criteria for poly-TBI. Latent class analysis yielded 3 poly-TBI classes: class 1-mixed; class 2-SDH/SAH; and class 3-EDH/SAH. Class 1-mixed had a higher likelihood of SDH, SAH, and ICH, and a lower likelihood of EDH. Class 2-SDH/SAH had a higher likelihood of only SDH and SAH. Class 3-EDH/SAH had a higher likelihood of EDH and SAH, and a lower likelihood of SDH and ICH. Class 1-mixed was relatively more likely to have an RCT score of 2. Class 2-SDH/SAH was relatively more likely to have an RCT score of 2, 3, and 4. Class 3-EDH/SAH had a higher likelihood of an RCT score of 3, 4, and 5. Class 1-mixed had significantly lower mortality (χ2 = 7.968; p = 0.005) and less WLST (χ2 = 4.618; p = 0.032) than Class 2-SDH/SAH. Class 2-SDH/SAH had the highest probability of death (0.612), followed by class 3-EDH/SAH (0.385) and class 1-mixed (0.277). Similarly, class 2-SDH/SAH had the highest WLST probability (0.498), followed by class 3-EDH/SAH (0.615) and class 1-mixed (0.238). CONCLUSIONS: Distinct poly-TBI classes were associated with increased in-hospital mortality and WLST. Further research with larger datasets will allow for more comprehensive poly-TBI class definitions and outcomes analysis.

Surgical Challenges and Outcomes in Treating a Floating Upper Arm With Multiple Humerus Fractures and Radial Neck Fractures.

Complex humerus fractures associated with high-energy trauma present significant surgical challenges due to their impact on limb functionality and structural integrity. This case report details the treatment of a floating upper arm injury, characterized by multiple humerus fractures and a radial neck fracture, in a 50-year-old male following a vehicular accident. The patient exhibited fractures at the proximal, mid-shaft, and distal segments of the humerus, necessitating an integrated surgical approach to effectively manage these injuries. Dual surgical approaches and perpendicular plating were employed to address the multifaceted nature of the fractures. The patient achieved satisfactory functional recovery, regaining a significant range of motion, which highlights the efficacy of the chosen surgical strategy. This case contributes to the existing literature by illustrating the benefits of specific surgical techniques in managing complex humerus fractures, emphasizing the necessity for meticulous planning and execution to optimize patient outcomes.

External Validation of Predictors of Mortality in Polytrauma Patients.

INTRODUCTION: The Parkland Trauma Index of Mortality (PTIM) is an integrated, machine learning 72-h mortality prediction model that automatically extracts and analyzes demographic, laboratory, and physiological data in polytrauma patients. We hypothesized that this validated model would perform equally as well at another level 1 trauma center. METHODS: A retrospective cohort study was performed including ∼5000 adult level 1 trauma activation patients from January 2022 to September 2023. Demographics, physiologic and laboratory values were collected. First, a test set of models using PTIM clinical variables (CVs) was used as external validation, named PTIM+. Then, multiple novel mortality prediction models were developed considering all CVs designated as the Cincinnati Trauma Index of Mortality (CTIM). The statistical performance of the models was then compared. RESULTS: PTIM CVs were found to have similar predictive performance within the PTIM + external validation model. The highest correlating CVs used in CTIM overlapped considerably with those of the PTIM, and performance was comparable between models. Specifically, for prediction of mortality within 48 h (CTIM versus PTIM): positive prediction value was 35.6% versus 32.5%, negative prediction value was 99.6% versus 99.3%, sensitivity was 81.0% versus 82.5%, specificity was 97.3% versus 93.6%, and area under the curve was 0.98 versus 0.94. CONCLUSIONS: This external cohort study suggests that the variables initially identified via PTIM retain their predictive ability and are accessible in a different level 1 trauma center. This work shows that a trauma center may be able to operationalize an effective predictive model without undertaking a repeated time and resource intensive process of full variable selection.

French practice of emergency resuscitative thoracotomy. A study based on the Traumabase Registry.

AIM OF THE STUDY: Emergency resuscitative thoracotomy (ERT) has been described as a potentially life-saving procedure for trauma patients who have been admitted in refractory shock or with recent loss of sign of life (SOL). This nationwide registry analysis aimed to describe the French practice of ERT. PATIENTS AND METHODS: From 2015 to 2021, all severe trauma patients who underwent ERT were extracted from the TraumaBase→ registry. Demographic data, prehospital management and in-hospital outcomes were recorded to evaluate predictors of success-to rescue after ERT at 24-hour and 28-day. RESULTS: Only 10/26 Trauma centers have an effective practice of ERT, three of them perform more than 1 ERT/year. Sixty-six patients (74% male, 49/66) with a median age of 37 y/o [26-51], mostly with blunt trauma (52%, 35/66) were managed with ERT. The median pre-hospital time was 64mins [45-89]. At admission, the median injury severity score was 35 [25-48], and 51% (16/30) of patients have lost SOL. ERT was associated with a massive transfusion protocol including 8 RBCs [6-13], 6 FFPs [4-10], and 0 PCs [0-1] in the first 6h. The overall success-to-rescue after ERT at 24-h and 28-d were 27% and 15%, respectively. In case of refractory shock after penetrating trauma, survival was 64% at 24-hours and 47% at 28-days. CONCLUSIONS: ERT integrated into the trauma protocol remains a life-saving procedure that appears to be underutilized in France, despite significant success-to-rescue observed by trained teams for selected patients.

The Role of External Fixation in the Treatment of Distal Radius Fractures.

There are numerous internal fixation (IF) options available for distal radius fractures (DRFs). The choice of fixation method depends on factors such as fracture morphology, soft tissue integrity, the patient's clinical status, and the surgeon's training. While volar plate fixation has become the primary approach for addressing these fractures, alternative IF methods like K-wire fixation, fragment-specific fixation, and dorsal bridge plating continue to be effective. Despite the versatility of IF, there are certain clinical situations where prompt and conclusive management through open reduction and internal fixation (ORIF) is not suitable. These instances include the treatment of polytraumatized patients, individuals with compromised soft tissues, or those medically unstable to tolerate lengthy anesthesia. In such cases, proficiency in closed reduction and external fixation (EF) proves invaluable. Being able to identify these clinical scenarios and comprehend the efficacy and safety of EF in addressing DRFs is valuable for any surgeon handling such injuries.

Body composition parameters in initial CT imaging of mechanically ventilated trauma patients: Single-centre observational study.

BACKGROUND: Body composition parameters provide relevant prognostic significance in critical care cohorts and cancer populations. Published results regarding polytrauma patients are inconclusive to date. The goal of this study was to analyse the role of body composition parameters in severely injured trauma patients. METHODS: All consecutive patients requiring emergency tracheal intubation and mechanical ventilation before initial computed tomography (CT) at a level-1 trauma centre over a 12-year period (2008-2019) were reanalysed. The analysis included CT-derived body composition parameters based upon whole-body trauma CT as prognostic variables for 30-day mortality, intensive care unit length of stay (ICU LOS) and mechanical ventilation duration. RESULTS: Four hundred seventy-two patients (75% male) with a median age of 49 years, median injury severity score of 26 and 30-day mortality rate of 22% (104 patients) met the inclusion criteria and were analysed. Regarding body composition parameters, 231 patients (49%) had visceral obesity, 75 patients had sarcopenia (16%) and 35 patients had sarcopenic obesity (7.4%). After adjustment for statistically significant univariable predictors age, body mass index, sarcopenic obesity, visceral obesity, American Society of Anesthesiologists classification ≥3, injury severity score and Glasgow Coma Scale ≤ 8 points, the Cox proportional hazard model identified sarcopenia as significant prognostic factor of 30-day mortality (hazard ratio 2.84; 95% confidence interval 1.38-5.85; P = 0.004), which was confirmed in Kaplan-Meier survival analysis (log-rank P = 0.006). In a subanalysis of 363 survivors, linear multivariable regression analysis revealed no significant associations of body composition parameters with ICU LOS and duration of mechanical ventilation. CONCLUSIONS: In a multivariable analysis of mechanically ventilated trauma patients, CT-defined sarcopenia was significantly associated with 30-day mortality whereas no associations of body composition parameters with ICU LOS and duration of mechanical ventilation were observed.

Development and validation of a machine learning-based model to assess probability of systemic inflammatory response syndrome in patients with severe multiple traumas.

BACKGROUND: Systemic inflammatory response syndrome (SIRS) is a predictor of serious infectious complications, organ failure, and death in patients with severe polytrauma and is one of the reasons for delaying early total surgical treatment. To determine the risk of SIRS within 24 h after hospitalization, we developed six machine learning models. MATERIALS AND METHODS: Using retrospective data about the patient, the nature of the injury, the results of general and standard biochemical blood tests, and coagulation tests, six models were developed: decision tree, random forest, logistic regression, support vector and gradient boosting classifiers, logistic regressor, and neural network. The effectiveness of the models was assessed through internal and external validation. RESULTS: Among the 439 selected patients with severe polytrauma in 230 (52.4%), SIRS was diagnosed within the first 24 h of hospitalization. The SIRS group was more strongly associated with class II bleeding (39.5% vs. 60.5%; OR 1.81 [95% CI: 1.23-2.65]; P = 0.0023), long-term vasopressor use (68.4% vs. 31.6%; OR 5.51 [95% CI: 2.37-5.23]; P < 0.0001), risk of acute coagulopathy (67.8% vs. 32.2%; OR 2.4 [95% CI: 1.55-3.77]; P < 0.0001), and greater risk of pneumonia (59.5% vs. 40.5%; OR 1.74 [95% CI: 1.19-2.54]; P = 0.0042), longer ICU length of stay (5 ± 6.3 vs. 2.7 ± 4.3 days; P < 0.0001) and mortality rate (64.5% vs. 35.5%; OR 10.87 [95% CI: 6.3-19.89]; P = 0.0391). Of all the models, the random forest classifier showed the best predictive ability in the internal (AUROC 0.89; 95% CI: 0.83-0.96) and external validation (AUROC 0.83; 95% CI: 0.75-0.91) datasets. CONCLUSIONS: The developed model made it possible to accurately predict the risk of developing SIRS in the early period after injury, allowing clinical specialists to predict patient management tactics and calculate medication and staffing needs for the patient. LEVEL OF EVIDENCE: Level 3. TRIAL REGISTRATION: The study was retrospectively registered in the ClinicalTrials.gov database of the National Library of Medicine (NCT06323096).

Association of trauma classifications to long-term outcome in blunt trauma patients.

PURPOSE: The impact of major trauma is long lasting. Although polytrauma patients are currently identified with the Berlin polytrauma criteria, data on long-term outcomes are not available. In this study, we evaluated the association of trauma classification with long-term outcome in blunt-trauma patients. METHODS: A trauma registry of a level I trauma centre was used for patient identification from 1.1.2006 to 31.12.2015. Patients were grouped as follows: (1) all severely injured trauma patients; (2) all severely injured polytrauma patients; 2a) severely injured patients with AIS ≥ 3 on two different body regions (Berlin-); 2b) severely injured patients with polytrauma and a physiological criterion (Berlin+); and (3) a non-polytrauma group. Kaplan-Meier survival analysis was performed to estimate differences in mortality between different groups. RESULTS: We identified 3359 trauma patients for this study. Non-polytrauma was the largest group (2380 [70.9%] patients). A total of 500 (14.9%) patients fulfilled the criteria for Berlin + definition, leaving 479 (14.3%) polytrauma patients in Berlin- group. Berlin + patients had the highest short-term mortality compared with other groups, although the difference in cumulative mortality gradually plateaued compared with the non-polytrauma patient group; at the end of the 10-year follow up, the non-polytrauma group had the greatest mortality due to the high number of patients with traumatic brain injury (TBI). CONCLUSION: Excess mortality of polytrauma patients by Berlin definition occurs in the early phase (30-day mortality) and late deaths are rare. TBI causes high early mortality followed by increased long-term mortality.

Morel-Lavallee Lesion Associated With Rhabdomyolysis in Polytrauma.

We describe the case of a 30-year-old man who allegedly had a history of road traffic accidents. While walking on the road, he was hit by a truck. He presented with complaints of facial injuries and being unable to move his right lower limb. On examination, there is a 15x4 cm lacerated wound in the perineal area, with left testes exposed; anal tone could not be assessed; the right lower limb is externally rotated; and deformity is present with palpable peripheral pulses. He was diagnosed with a right sacral ala fracture, a distal one-third shaft of the right tibia fracture, and a right suprapubic rami fracture. Ultrasound of the right thigh showed hematoma and subcutaneous edema all around the gluteal and inguinal regions and fluid collection in the right inguinal region, which is suggestive of Morel-Lavallee lesion (MLL) type 6. On day two of admission, urine was dark in color, and creatinine kinase was elevated, which is suggestive of rhabdomyolysis. He was managed with hydration, electrolyte correction for rhabdomyolysis, and wound debridement for MLL apart from perineal injury, right sacral ala fracture, right suprapubic rami fracture, and distal one-third shaft of the right tibia fracture, with perineal repair and loop colostomy, pelvic binder, and external fixator, respectively. Early identification of the MLL associated with rhabdomyolysis in this polytrauma patient led to recovery and a successful outcome.

Rehabilitation systems: trauma centers Asia-Pacific (Australia and Japan).

Rehabilitation systems in Australia and Japan represent a multidisciplinary team approach that have similarities and differences. Treatment is based on a goal-driven, holistic, patient-centered approach. This article provides an overview of the structure of the rehabilitation systems in Australia and Japan, including written guidelines, in-hospital programs, and postdischarge options.

A preliminary investigation of the utility of the Word Memory Test Immediate Recognition trial as a screener for noncredible performance.

The assessment of performance validity is an important consideration to the interpretation of neuropsychological data. However, commonly used performance validity tests such as the Test of Memory Malingering (TOMM) and Word Memory Test (WMT) have lengthy administration times (20-30 minutes). Alternatively, utilizing a screener of performance validity (e.g., the TOMM T1 or TOMMe10) has proven to be an effective method of assessing performance validity while conserving time. The present study investigates the use of the WMT Immediate Recognition (IR) Trial scores as a screening measure for performance validity using an archival mTBI polytrauma sample (n = 48). Results show that the WMT IR demonstrates a high degree of accuracy in predicting WMT Delayed Recognition (DR) Trial performance across a range of base rates suggesting that the WMT IR is a useful screening measure for noncredible performance. Clinical implications and selection of optimal cutoff are discussed.