Trauma Care, Volume 3, Issue 3 (September 2023) – 9 articles

Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures. Full article

This study examines the psychological repercussions of the COVID-19 pandemic on a medical team in an Israeli general hospital. The research explores the professional quality of life, burnout symptoms, secondary traumatic stress, and mindfulness among team members across three distinct phases of the pandemic. Analysis was conducted for different subgroups based on job roles and seniority, allowing for an evaluation of the phase-specific effects on ProQOL (Professional Quality of Life) and mindfulness. Results align with established crisis trajectories: honeymoon/heroic phases, inventory, disillusionment, and recovery. As a result of the prolonged pandemic and the need to change shifts and recruit staff to deal with the affected patients, it is an accumulative study not following the same person but the same ward and the same hospital. The findings suggest a negative correlation between compassion satisfaction and burnout, as well as between mindfulness and burnout/secondary traumatic stress. Unlike most studies, healthcare workers (HCWs) were less affected than doctors in all measures. This study highlights doctors’ vulnerability and underscores hospital management’s key role in promoting effective support for professional quality of life. This is especially important for male doctors facing distinct well-being challenges. Full article

The impact of early maternal age on several outcomes (e.g., mental health issues, delinquency, aggression, impulsivity, victimization, and interpersonal difficulties) has been studied since the late 1980s. Research has demonstrated links between exposure to adverse childhood experiences (ACEs) and trauma-related outcomes such as substance abuse, interpersonal and self-directed violence, and sexual risk-taking, to name a few. The current study analyzed the incidence of ACE exposure and mental health outcomes (e.g., suicidal behaviors or self-harm, psychiatric hospitalizations, and substance use) as related to early maternal age in youth known to have experienced trafficking or sexual abuse. General demographics and incidence of various experiences and clinical presentations (e.g., ACE exposure, age of mother at birth of youth, and age at first birth), and history of self-harm, substance use, and psychiatric hospitalization, were examined in a sample of 225 youth referred for services subsequent to experiences of sex trafficking or exploitation. Relationships between ACE exposure and maternal age related to mental health outcomes were also examined. Trafficked and exploited youth reported rates of ACE exposure and poor mental health outcomes at far greater rates than the general population. Significant findings were related to early maternal age and engaging in self-harm or suicidal behaviors. Previously anticipated mediational analyses were not conducted due to the sample size and lack of correlations. Findings highlight the significant ACE exposure and high needs of exploited, trafficked, and abused youth and related mental health outcomes, emphasizing the need for early and comprehensive preventive and therapeutic interventions. Full article

For women and families of refugee background having a baby in Australia, trauma-related experiences contribute to maternal and neonatal health inequities. Group Pregnancy Care for women of refugee background is a new model of care that was codesigned with communities of refugee background, to incorporate a trauma-informed approach to care. The aim of this paper is to explore how trauma-informed care is understood by Group Pregnancy Care professional staff. An exploratory descriptive qualitative study involving twenty-three semi-structured interviews with past and present professional staff was conducted. Data were analysed using reflexive thematic analysis. The results reported in this paper include five themes: acknowledging the universal potential for trauma; accountability to community; practising in trauma-informed ways; how can we determine whether trauma-informed care is happening?; and understanding equity. The analysis showed that GPC staff aimed to practise in trauma-informed ways and understood that their ability to integrate trauma-informed care could improve over time. However, there were times when participants perceived organisation- or structural-level barriers that were incongruous with their understanding of health equity, which created tension and led to feelings for some of being in a ‘battle against the system’. Key individual- and organisation-level factors were identified that assisted with integrating trauma-informed care, including a safe and accessible space to hold the program, strategies to minimise the risk of retraumatisation and burnout, and adequate time to facilitate group processes and support staff to participate in team reflective practises. Understanding trauma-informed care and equity were seen to have important implications for workforce wellbeing and the promotion of refugee maternal and child health. Full article

Individuals with traumatic experiences may develop symptoms of post-traumatic stress disorder (PTSD) and co-morbid disorders, such as anxiety disorders, major depression, and substance use disorder. Although exposure therapy is considered the “gold standard” for the treatment of PTSD, dropout rates and patient distress are relatively high. One promising approach is live Z-score neurofeedback (ZNF) training, but clinical evidence is sparse. Thus, the current study aimed to evaluate the feasibility and acceptability of ZNF training among individuals with PTSD. After undergoing a diagnostic interview utilizing the MINI Neuropsychiatric Interview, nine patients with PTSD (7 females; mean age = 20.75 [SD = 2.38]) completed ten ZNF sessions, lasting 20 min each, and the PCL-5 at pre- and post-treatment. Over the course of the study, only a few minor study disruptions, adverse events, and patient complaints were reported, and participants rated high on feasibility and acceptability. Results from repeated measures ANOVAs suggest significant improvements in overall PTSD symptoms. Although these findings need to be replicated in larger samples with active control groups, the current study provides support that ZNF is a safe, acceptable, and potentially effective treatment for PTSD. Full article

Liposuction is one of the most commonly performed aesthetic plastic surgery procedures in the world. Although serious complications are rare, intra-abdominal complications such as bowel perforation are one of the most common causes of death after liposuction. We present a case series of six patients who sustained intra-abdominal injuries from liposuction. The acute care surgery (ACS) faculty at a single institution were surveyed for patients. Six patients were identified over a three-year period. The average age was 45 years, and all patients were female. All six underwent a cosmetic procedure in addition to their liposuction. Four (67%) had previous abdominal surgery, and five (83%) were overweight or obese. All patients presented with abdominal pain, tachycardia, and leukocytosis. All six underwent exploratory laparotomies: four patients had small bowel enterotomies, one had cecal volvulus and abdominal compartment syndrome, and one had fascial violation. They underwent an average of four ACS procedures (range 1 to 11) and had an average hospital LOS of 29 days (range 5 to 60) and an average ICU LOS of 11 days (range 1 to 39). Intra-abdominal injuries are a rare complication of liposuction; however, a high index of suspicion must be maintained to diagnose and treat these life-threatening injuries. Full article

Disability is associated with negativity, discrimination, shame, and stigma in townships, which impacts how parents interpret it when their child has a disability. Parents who have recently learned of their children’s intellectual disability often experience psychological and emotional trauma due to uncertainty and lack of knowledge and understanding of intellectual disabilities, including a lack of formalized and policy-supported transition programs in South Africa. Guided by Barbara Mowder’s Parent Development Theory, this study aimed to explore parents’ understanding of their role in transitioning learners with intellectual disabilities from mainstream to special schools. Using a qualitative case study, semi-structured interviews were conducted with eight purposively sampled participants from one chosen mainstream primary school in Soweto, Gauteng Province, South Africa. The results of the current study confirmed that the meanings participants attribute to their parent role characteristics during the transitioning of their children with intellectual disabilities are influenced by the connection between the Parent Development Theory’s parent role perceptions and the participants’ individual factors, including their educational background levels, which made a major contribution to how these parents perceived their parental role and their understanding of intellectual disabilities. The results highlight that owing to parents’ educational levels and cultural aspects, identifying learners with intellectual disabilities can be particularly challenging, with overwhelming, mixed emotions. The provision of psychosocial services in mainstream schools, as well as teacher training in skills to address the overwhelming parental support needs, will benefit parents and their intellectually disabled children by facilitating therapy and counseling during the transition process to overcome psychological challenges. Full article

Background: Ongoing evidence of trauma in nurses, beginning in nursing school, requires educators to take a trauma-informed approach to teaching and learning to minimize re-traumatization and to ultimately achieve socially-just student outcomes. Methods: The purpose of this study was to evaluate the outcomes of trauma-informed educational practices (TIEP) on nursing students and the trauma-informed climate in the classroom using an intervention comparison group pre-posttest design. Results: Secondary traumatic stress (STS) scores declined for both groups pre- to post-test. There was a statistically significant difference in STS change scores between intervention and comparison groups (p < 0.05), but not in the direction hypothesized. Conclusion: Findings from this study indicate that other factors in the nursing classroom might have contributed significantly to a reduction in STS. In addition to outcomes, future TIEP evaluations should explore student awareness and experiences of trauma, resilience, professional preparation, and learning outcomes in the classroom setting. Full article

Background: Craniofacial injuries are thought to be commonly associated with traumatic brain injury (TBI), but there is conflicting evidence in the literature. This retrospective cohort study aims to evaluate the incidence of TBI in patients with craniofacial trauma. Methods: The study included 2982 consecutive patients with either solitary or concurrent diagnoses of TBI and facial fractures, seen and evaluated at a single level II trauma center between 1 January 2010 and 31 December 2020. Continuous variables were compared against whether the patient had one or both diagnoses. Results: Of the target population, 55.8% had a solitary diagnosis of TBI; 30.28% had a solitary diagnosis of facial fractures; and 13.92% had concurrent diagnoses of both TBI and facial fractures. Patients with concurrent diagnoses had a significantly longer mean length of stay (LOS) compared to those with solitary diagnoses (9.92 ± 16.33 days vs. 6.21 ± 10.96 days, p < 0.01), but age (p = 0.68) and ICU LOS (p = 0.09) did not differ significantly between the two groups. Conclusions: Trauma to the face should be given special attention due to the increased chance of TBI with craniofacial fractures. Patients with concurrent diagnoses of TBI and facial fractures had worse hospital outcomes than those with solitary diagnoses of either TBI or facial trauma. Full article