A bony mallet finger refers to an avulsion fracture at the dorsal base of the distal phalanx. When the fracture fragment involves more than one-third of the articular surface and is accompanied by volar subluxation of the DIP joint, the joint's stability is compromised. In this setting, surgical treatment is often necessary. Open reduction and hook plate fixation provide the most rigid fixation and have become increasingly popular. However, surgical approaches - including Y-, H-, S-, and U-shaped incisions - are frequently associated with complications such as skin necrosis, nail deformity, and implant extrusion. Treating bony mallet finger with a hook plate is challenging. This retrospective case series study involved a review of 26 patients who underwent surgical treatment for bony mallet finger between May 2019 and December 2022. Our objective is to describe a novel surgical approach using double parallel dorsal longitudinal incisions for fixing mallet fractures. Additionally, we provide the preliminary results to evaluate its effectiveness.
This systematic review looks at burn injuries in the Gulf region over the past five years, focusing on how often they occur, their survival and complication rates, and current prevention efforts. To gather the data, two reviewers independently searched five major databases and checked article reference lists to make sure no relevant studies were missed. The team then used the Newcastle-Ottawa Scale (NOS) to evaluate the quality and potential bias of the gathered research. The following sections present these regional findings and discuss the need for better burn management systems and stronger prevention strategies across the Gulf countries. OBJECTIVES:(1) To examine burn epidemiology. (2) To assess morbidity and mortality. (3) And to cover preventative strategies in the gulf countries (Qatar, UAE, Oman, Bahrain, Saudi Arabia) over the past 5 years. METHODS:(1) Data extraction was performed independently by two reviewers utilizing a standardized form. To ensure data integrity, this instrument was initially piloted on three studies, with iterative modifications implemented as necessary before full-scale deployment. (2) A systematic literature search was conducted across five major electronic databases: PubMed, Embase, Google Scholar, Web of Science, and Scopus. To ensure literature saturation, the reference lists of all relevant articles were manually screened to identify additional eligible studies. RESULTS:(1) A quantitative meta-analysis was precluded by substantial heterogeneity in study methodologies, patient cohorts, and outcome assessments. Regarding methodological quality, twelve trials (60%) exhibited a moderate risk of bias, while two demonstrated a low risk and four presented a high risk. Evaluation via the Newcastle-Ottawa Scale (NOS) indicated that nine to ten studies maintained high transparency in both data collection and methodological reporting. (2) Highest rate of mortality was found in saudi arabia (17.6%) and second highest in Kuwait (10.9%). CONCLUSIONS:(1) There is a high degree of variation in burn epidemiology, mortality, and prognosis among various Gulf countries. Which emphasizes a need for a uniform burn management system. (2) To effectively reduce burn-related morbidity and mortality, a comprehensive escalation of current preventative strategies is required.
In clinical practice, tracheal intubation entails flexing a tracheal tube with a stylet and inserting it into the glottis under the guidance of videolaryngoscopy. Nevertheless, this approach may trigger intense sympathetic responses and elevate the risk of intubation failure. To address these issues, our research team put forward a minimally invasive intubation technique by using SEE-VL and SEEKflex, which is anticipated to enhance the first-pass success rate of intubation and mitigate stress reactions. This novel technology is expected to minimize the trauma associated with intubation and improve patients' comfort during medical treatment.
Delayed evacuation creates a critical gap between point-of-injury care and definitive surgical management in battlefield trauma. Although Damage Control Orthopedics (DCO) is an established strategy for physiologically unstable trauma patients, it is usually implemented after evacuation and depends on higher-level medical support. We propose Battlefield Monitoring and Stabilization (BMS) as a forward-deployed conceptual framework for earlier battlefield care. BMS emphasizes temporary stabilization, hemorrhage-oriented intervention, basic physiological support, and portable monitoring before evacuation and definitive treatment. Proposed applications include point-of-injury stabilization, prolonged field care, and en-route casualty management. Several enabling components, including a rapidly assembled pelvic stabilization device, are under development. Relevant evaluation domains include fixation speed, hemostatic performance, monitoring accuracy, portability, and environmental adaptability. Further validation is warranted.
OBJECTIVE:The purpose of this scoping review is to compile the evidence regarding the use of computed tomography (CT) to distinguish between benign and malignant vertebral compression fractures (VCFs) in artificial intelligence (AI) applications. METHODS:We systematically searched PubMed/MEDLINE, DOAJ, and ScienceDirect through October 2025 for studies reporting AI-based diagnostic approaches (machine learning with radiomics features, deep learning with convolutional neural networks, or hybrid models) applied to CT images in adult patients with VCFs. Eligible studies required diagnostic performance metrics and definitive reference standards. RESULTS:Six retrospective studies from Asia and Europe have been found, involving 1,767 participants with 3,408 vertebrae, including 1,257 benign and 1,442 malignant vertebral fractures. The diagnostic performance of AI algorithms is high, achieving an area under the curve (AUC) score from 0.76 to 0.99. Deep learning approaches achieved performance comparable to experienced radiologists, while radiomics-based methods provided interpretable quantitative features. Hybrid models combining both approaches showed synergistic benefits. Three studies with external validation confirmed reasonable generalizability, though with some performance reduction in independent datasets. CONCLUSIONS:AI-assisted evaluation of CT scans also has good potential in differentiating benign from malignant VCFs, which could reduce unnecessary MRI referrals and improve the initial evaluation time. However, the data regarding this are limited because of retrospective studies with variable methods and limited multicenter data, which are still required to implement this in routine clinical practice.
BACKGROUND:Traumatic brain injury (TBI) induces systemic responses, including neurogenic cardiac injury via the brain-heart axis, manifesting as electrocardiographic (ECG) abnormalities that may predict outcomes. OBJECTIVE:This systematic review aimed to evaluate the diagnostic and prognostic utility of ECG monitoring in patients with TBI, identify knowledge gaps, and guide future research. METHODS:Following PRISMA guidelines, we searched PubMed and Google Scholar (January 2020 - March 2025) for studies on adult patients with TBI (≥ 16 years) who underwent acute ECG assessment (≤ 72 hours post-injury). The inclusion criteria focused on observational/cohort studies that reported ECG changes, severity correlations, and outcomes. The exclusion criteria were pediatric cases, pre-existing cardiac conditions, and non-English articles. Data were extracted from the eligible studies. RESULTS:Six studies (1,642 patients) revealed ECG abnormalities in 10-88% of cases, increasing with TBI severity (e.g., prolonged QTc in 3% of mild cases vs. 15% of severe cases). Common changes included repolarization issues (QTc prolongation and ST-segment/T-wave alterations), arrhythmias, and conduction disturbances. Abnormalities often resolved within days, improved post-neurosurgery (e.g., reduced QTc), and predicted mortality (e.g., QTc prolongation/ST depression as independent factors) and cardiac dysfunction. CONCLUSION:ECG changes are prevalent in TBI, correlate with severity, and have prognostic value for risk stratification. Routine monitoring is recommended, and larger, standardized studies are needed to optimize management.
For the repair of complex wounds involving bone and joint infections resulting from severe trauma, the conventional approach typically involves a two-stage procedure: initial implantation of an artificial dermis (AD), followed by autologous split-thickness skin grafting (STSG) after 2-3 weeks. This report presents an innovative onestage technique in which AD and autologous STSG were transplanted simultaneously onto a wound bed prepared with antibiotic-loaded bone cement (ALBC). The patient had sustained multiple open fractures, dislocations, bone defects, and bone and joint infections following a traffic accident. After two initial surgical procedures that included thorough debridement, fracture fixation, and ALBC placement for infection control, a one-stage skin graft was performed to co-implant AD and autologous STSG (0.15-0.25 mm thick) for wound closure. At the 18-month follow-up, the graft flap exhibits no contraction, and its color, texture, softness, and elasticity closely resemble those of the surrounding normal skin. This ALBC-assisted one-stage transplantation of AD combined with autologous STSG offers a feasible and efficient method for repairing complex wounds involving bone and joint injuries with concomitant skin and soft tissue defects. Moreover, it may reduce treatment duration and simplify the clinical pathway compared with traditional two-stage skin grafting protocols.
In this article we present a case of a large anterior elbow defect and an ipsilateral post-mastectomy defect reconstructed simultaneously using a single latissimus dorsi pedicle flap, split into two separate skin islands based on its independent vascular branches. To the best of our knowledge, no previous cases utilizing this approach for simultaneous treatment of mastectomy and distal arm tissue defects have been reported. Therefore, it was deemed relevant to share the technical aspects of the surgical procedure. The case involves a 61-year-old woman of Caucasian origin, diagnosed with breast cancer of the left breast. She underwent a modified radical mastectomy. Postoperative radiotherapy and chemotherapy were administered. During a chemotherapy infusion, extravasation of the chemotherapeutic agent led to necrosis in the left elbow and distal upper arm regions. The patient was primarily treated at another facility with skin grafting. We performed a reconstruction with a pre-expanded latissimus dorsi pedicle flap divided into two independent myocutaneous flaps for the upper extremity and mastectomy defects. The left breast underwent delayed combined reconstruction with the myocutaneous flap and a silicone implant. The upper extremity defect was simultaneously reconstructed with the other part of the same flap. The whole reconstruction included three operative stages. The blood supplyto the transferred tissues was excellent and no complications occurred. The constant vascular anatomy of the thoracodorsal vessels and their intramuscular distribution pattern provides a robust amount of healthy tissue, which can be successfully used for treating a variety of defects within the flaps rotational arc. This allows for the reconstruction of different anatomical regions. Based on this case we demonstrate that coverage of a large elbow defect and simultaneous breast reconstruction is possible by splitting a pre-expanded pedicle latissimus dorsi flap into two independent flaps.
OBJECTIVE:This systematic review aimed to conduct a comprehensive comparative analysis of the diagnostic performance of magnetic resonance imaging (MRI) and ultrasound (US) in detecting rotator cuff tears (RCTs). METHODS:A systematic literature search was conducted in the PubMed, Scopus, and Embase databases from January 2021 to March 2025 for original studies on adults (≥18 years) with suspected RCTs undergoing both US and MRI. Thirteen studies involving 792 participants met the inclusion criteria. RESULTS:US was better than MRI for full-thickness tears, with a sensitivity of 100% (especially for supraspinatus), a specificity of 81-100%, and a kappa of up to 1.0. For partial-thickness tears, the results varied (sensitivity 72-94%, accuracy 76-94%). Non-supraspinatus tendons were less reliable, and the results were affected by the operator's skill, the patient's sex (worse in females), and the side of the body. MRI was better for partial tears, complicated cases, and planning surgery. CONCLUSION:The findings demonstrate that US can serve as a valuable auxiliary imaging modality for rotator cuff evaluation, particularly excelling in detecting full-thickness tears when MRI is contraindicated, unavailable, or in resource-limited settings. While US shows excellent diagnostic performance for full-thickness supraspinatus tears, MRI remains the primary diagnostic standard in clinical practice for comprehensive rotator cuff assessment, particularly for partial tears, complex pathologies, and detailed pre-operative planning.
Intraoperative blood loss (IBL) monitoring is an important factor in decision-making of anesthesia, and real-time and reliable IBL is vital in the safety of the patient during the perioperative period. But even now after decades of technological development in medicine, this basic clinical issue has not been addressed. The current strategies of monitoring do not usually achieve all the needs of accuracy, timeliness, and procedural flexibility in regular clinical care. This article re-examines this critical issue of intraoperative blood loss monitoring from the perspective of actual clinical surgery and anesthesiology. We analyzed the structural reasons for the long-term unreliability of IBL clinical measurements and proposed some core principles for future surveillance strategies. Traditional methods for assessing intraoperative blood loss include visual estimation, gravimetric methods, volumetric methods, and laboratory or spectrophotometric methods. These methods all have inherent limitations. We believe these shortcomings are not isolated technical problems, but rather stem from a design philosophy that did not address the needs of clinical decision-making from the outset. To better explain the clinical challenges faced by IBL monitoring, we propose the "Irreconcilable Triangle of IBL Monitoring" model. This model consists of three conflicting requirements: accuracy, timeliness, and workflow compatibility. Optimizing one dimension of technology inevitably compromises other dimensions. Therefore, we redefine accuracy as "functional accuracy". That is, the accuracy of intraoperative bleeding monitoring should reach the level necessary to support intraoperative clinical decision-making, without pursuing absolute accuracy. Simultaneously, it should be made as time-relevant and clinically feasible as possible to meet clinical needs. This paper envisions future strategies for intraoperative blood loss monitoring. Future clinical practice requires automated equipment capable of continuously quantifying free blood, absorbed blood, and blood clots, shifting from inferential estimation to direct automated measurement. Furthermore, this equipment must be seamlessly integrated into the anesthesia workflow. The paper discusses the availability of artificial intelligence (AI) in surgical blood loss monitoring. We believe that while AI has limitations in interpretability, it can serve as a complication prediction and backend computational tool for the entire monitoring system. In the future, we hope to develop IBL monitoring into an integrated system centered on clinical usability and decision relevance through new technology development and system integration.
OBJECTIVE:This study aimed to investigate the clinical application of Wound Care Ointment combined with Vaseline gauze for the repair of split-thickness skin graft donor sites. METHODS:A total of 64 patients who met the inclusion criteria were included. The study group (32 patients) used Vaseline gauze lined with Wound Care Ointment to close the split - thickness skin graft donor sites, while Vaseline gauze was applied directly to the donor sites in the control group (32 patients). Demographic data, wound infection conditions, epithelialization time, the time of the first postoperative outer gauze replacement, Visual analogue scale (VAS) during the first postoperative outer gauze change and the number of layers of bleeding gauze were recorded for the selected patients. RESULTS:The epithelialization time of the donor site wound in the study group was significantly shorter than that in the control group [(10.09±0.93) days vs. (10.78±0.94) days, P<0.05]; VAS for the first postoperative change of the outer gauze in the study group was lower than that in the control group (2.47±0.84 vs. 3.53±1.14, P<0.05); the time for the first postoperative change of the outer gauze in the study group was later than that in the control group [(6.38±0.91) days vs. (5.78±1.26) days, P<0.05]; and the number of layers of bleeding gauze during the first postoperative change of the outer dressing in the study group was less than that in the control group (6.72±1.02 vs. 7.50±1.08, P<0.05). CONCLUSION:Wound Care Ointment is beneficial for the wound healing of split-thickness skin graft donor sites, which prolongs the first postoperative dressing change, reduces pain during the removal of the inner layer dressing, provides excellent wound protection and shortens the healing time. Therefore, Wound Care Ointment can be recommended for the repair of split-thickness skin graft donor sites.
With the transition to large-scale combat operations (LSCOs) and distributed warfare in theatre, medical evacuation times could be a lot longer, which challenges the "golden hour". In response to this challenge, the paper presents the "Core Region of Combat Trauma (CRCT)" as a novel framework for directing care in the Prolonged Casualty Care (PCC) phase when evacuation is prolonged. The CRCT is the site of injuries which are among the leading causes of potentially preventable deaths following Tactical Combat Casualty Care (TCCC). The care of CRCT located in the transitional phase between TCCC and damage control surgery. The guiding principle of CRCT management is damage control and physiological maintenance. This methodology facilitates the transition of casualties from a state where evacuation is not feasible to one where evacuation is tolerable.
OBJECTIVE:Comminuted intra-articular distal radius fractures (DRFs) present significant treatment challenges due to their complex morphology and tendency for post-traumatic arthritis. Volar plating alone may be insufficient to achieve and maintain reduction in dorsally displaced fractures. This prospective study evaluated the radiological and functional outcomes of dorsal-assisted volar plate fixation in dorsally displaced comminuted intra-articular DRFs. METHODS:A total of 21 patients treated at a tertiary care trauma centre were enrolled. All underwent dorsal-assisted reduction followed by volar plating without dorsal instrumentation and were followed for a minimum of one year (mean follow-up: 19.6 ± 4.7 months). Radiological outcomes were assessed using radial height, radial inclination, volar tilt, and intra-articular step-off, while functional outcomes were measured using the QuickDASH and modified Mayo Wrist scores. The study was prospectively registered in the Department review board in department of Orthopaedic Surgery, PGIMER, under registration number DRB/Ortho/2023/49. RESULTS:The mean patient age was 38 years, with a male predominance (17/21; 80.9%). Most fractures (15/21; 71.4%) were AO type 2R3C3. Postoperative evaluation demonstrated restoration of wrist alignment with a mean radial inclination of 23.35°, radial height of 11.29 mm, and volar tilt of 6.70°, closely approximating the uninjured wrist. Functional outcomes improved significantly from two months postoperatively to the final follow-up (P < 0.001), achieving a mean QuickDASH score of 4.95 and a modified Mayo Wrist Score of 90. Only two patients experienced minor complications related to implant prominence. CONCLUSIONS:Dorsal-assisted volar plating is a safe and effective technique for managing dorsally displaced comminuted intra-articular distal radius fractures, providing excellent anatomical restoration and functional recovery with minimal complications. It offers a valuable surgical option where volar plating alone may be inadequate.
OBJECTIVE:This study evaluates the efficacy of VELVERT, a novel antimicrobial dressing, compared to the standard Silver Sulfadiazine dressing in treating second-degree burns. METHOD:Conducted at a tertiary burn care center, 63 patients were enrolled and randomized into two groups: VELVERT (n = 31) and Silver Sulfadiazine (n = 30). The primary outcomes measured were wound closure percentage and time to complete healing within 24 days, while secondary outcomes included infection control, pain relief, and adverse events. The study was registered with CTRI with the registration number CTRI/2020/12/029698 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDY5MDc=&Enc=&userName=). RESULT:Among 61 patients who completed the study, 87% (27/31) in the VELVERT group achieved complete wound healing compared to 63% (19/30) in the Silver Sulfadiazine group. The BWAT score, assessing wound healing, showed a decline from 31.66 ± 3.15 to 15.55 ± 4.42 in the VELVERT group and from 31.55 ± 3.35 to 16.18 ± 5.37 in the Silver Sulfadiazine group (P = 0.176). Both treatments were well tolerated, but VELVERT exhibited superior wound healing outcomes. CONCLUSION:These findings suggest that VELVERT may serve as a more effective alternative for second-degree burn treatment, offering improved healing rates. Further research with larger sample sizes is recommended to validate its clinical benefits over standard treatments.
Pediatric burn injuries present unique challenges due to children's physiological vulnerabilities. This article provides a detailed analysis of the nutritional management of an 11-year-old patient with extensive burns affecting 60% of total body surface area. The patient received intensive care in a specialized pediatric burn unit, highlighting the fundamental role of nutrition in counteracting catabolic states and muscle loss frequently observed in these cases. Nutritional strategies-including gastrostomy infusion, albumin supplementation, and protein-enriched diets-were carefully implemented to optimize energy intake and promote wound healing. The article also reviews the metabolic and immunological responses of burn patients, emphasizing the importance of early nutritional support to mitigate hypermetabolism and enhance immune defense. Key elements of nutritional assessment, such as energy requirement estimation and macronutrient composition, are explored. Furthermore, the role of micronutrient supplementation in accelerating wound healing and reducing infectious complications is underscored. The article concludes by highlighting the evolving landscape of pediatric burn care, stressing the importance of interdisciplinary collaboration and the integration of advanced technologies to achieve precise nutritional interventions. This case study provides valuable insights into optimizing nutritional strategies for pediatric burn patients and contributes to the advancement of pediatric critical care.
The etiology of diabetic foot ulcers (DFU) is multifactorial, encompassing neuropathy, peripheral arterial disease, and susceptibility to infection. The management of DFU remains challenging due to high recurrence rates and amputation risks. While various treatments exist, a standardized, effective approach integrating holistic care is essential. This paper presents a detailed analysis of two representative cases of complex DFU managed within our institution. Both patients underwent a structured process involving immediate holistic assessment, formation of an MDT to devise personalized treatment strategies, surgery, application of NPWTi, and structured post-discharge planning including health education. Eventually, both patients achieved successful wound closure without major amputation. The successful management of complex DFU necessitates a paradigm shift from isolated interventions to a comprehensive strategy. This strategy should encompass 1) early holistic patient assessment, 2) centralized coordination via an MDT for personalized care plans, 3) meticulous surgical debridement, 4) judicious use of advanced adjunctive therapies like NPWTi, and 5) robust post-discharge follow-up and patient education to prevent recurrence. This framework serves as a practical guide until further robust evidence emerges to refine these recommendations.
BACKGROUND:Subtrochanteric femoral fractures in children are uncommon but challenging to manage due to high mechanical stresses and their proximity to the growth plate. While the Titanium Elastic Nailing System (TENS) has proven effective for paediatric diaphyseal fractures, its role in subtrochanteric fractures is less well established. AIM:The aim of this study was to evaluate the clinical and radiological outcomes of paediatric subtrochanteric femoral fractures treated with TENS, specifically assessing union rates, complications, and functional outcomes using Flynn's criteria. METHODS:We conducted a prospective observational study of 18 children aged 5-11 years with radiologicaly confirmed subtrochanteric femoral fractures treated using TENS at a tertiary care centre. Patient demographics, fracture patterns, associated injuries, time to surgery, postoperative immobilization, time to weight bearing, fracture union, complications, and outcomes were recorded and analysed. RESULTS:The mean age of patients was 7.7 years, with a male predominance (61%). The most common fracture patterns were oblique and spiral. Associated injuries were seen in 4 patients, and the average time to surgery was 2.1 days. Partial weight bearing was initiated by 4-5 weeks, and radiological union was achieved in all patients, with a mean union time of 9.5 weeks. Complications included limb length discrepancy (1 case), nail irritation (2 cases), and delayed union or malalignment (2 cases). According to Flynn's criteria, 72% had excellent, 22% good, and 6% satisfactory outcomes. CONCLUSION:TENS is a safe, minimally invasive, and effective treatment for paediatric subtrochanteric femoral fractures in children aged 5-11 years. When applied with proper technique and patient selection, it results in reliable union, early mobilization, and favourable functional outcomes with minimal complications.
BACKGROUND:Globally, burn injury is of public health concern; it is a significant health problem in both children and older adult populations. In Africa and especially in Uganda, burn injuries remain a major cause of prolonged hospital stays, disability, disfigurement and death. A lot of factors may be associated with the injury severity of burn wounds. Bacterial microorganisms take short hours to invade the burn wound and can be identified in the burn wounds less than 24 hours old. When a patient is alive after 3 days following a burn, then the commonest cause of death is infection. Bacterial infection is still the serious complication that might compromise with the patient's life after the early phase of the management, and the bacterial pathogens isolated from these wounds might still be resistant to the most common used antibiotics in our setting. OBJECTIVES:The aim of this study was to determine the most common etiology, the factors associated with injury severity, and the bacterial susceptibility patterns of burn patients in six selected hospitals in Uganda. METHODS:This cross-sectional study was conducted in the departments of surgery at the six selected hospitals from April to July 2022. RESULTS:Around 76 patients admitted to those hospitals with burns during our study period were included. Those who were very severe without caretakers eligible to consent for them were excluded. The average age was 17.7 years. There were slightly more males with a male-to-female ratio of 1.05. The majority were from the rural areas accounting for 76.3%. The common etiology was thermal, accounting for 80.8%, dominated by scalds (60.5%). Patients with burn wounds at the sites mandating admission were 22 times more likely to have a severe injury. The most common organism isolated was staphylococcus aureus accounting for 45.2%, followed by Pseudomonas, accounting for 15.5%, and they % were resistant to most of the antibiotics used in our study. Despite that identified bacteria were resistant to most of antibiotics, a good number of them were sensitive to imipenem, amikacin, ciprofloxacin, and cloxacillin. CONCLUSIONS:Implementation of burn infection control policies is needed. There is a need to include sites mandating admission in the parameters of the ABSI score. Based on microorganisms isolated, empirical treatment with ciprofloxacin or cloxacillin should be considered.
OBJECTIVE:To evaluate the effectiveness of virtual reality-based interventions in promoting functional recovery among individuals with burn injuries. DATA SOURCES:PubMed/Medline, Scopus, Ovid, CINAHL, PEDro, Google Scholar, and Cochrane Library. METHODS:Multiple data sources were explored from beginning to March 31, 2024, with study design of randomized clinical trials describing Range of Motion, enhanced ability for self-care (ADLs) and independence, quality of life in adult with burn injury. ROM was primarily measured using goniometers and electronic digital goniometers to assess the degrees of movement at affected joints before and after VR-based rehabilitation sessions. Two independent authors analyzed the results and selected the data. Cochrane Criteria Risk of Bias version 2 was used to measure risk of bias. Patient demographics, treatment regimen and outcome measuring tool, results and change in the patients' conditions were also extracted. Each study was appraised to check the level of evidence. RESULTS:8 publications were selected with a total of 293 patients included in these studies. Level of evidence analysis revealed that 8 studies were classified as level of evidence A2. The lowest PEDro score was 6 for one study only while other studies scored 7, 8, and 9 accordingly. In this review, seven studies were categorized as low risk of bias, while one study had some risk of bias. Our results showed that virtual reality can increase range of motion, enhanced ability for Self-Care (ADLs) and independence, improved quality of life in patients with burn injury, though strength of conclusion for mobility and ADLs was moderate. CONCLUSION:Preliminary evidence indicates that virtual reality "V.R." interventions could be beneficial in promoting functional recovery in patients with burn injuries. The studies reviewed suggest Virtual Reality can reduce pain during rehabilitation, improve range of motion, and increase patient engagement. However, the limited number of studies and the variability in VR methods and outcome measures restrict the generalizability of these findings. Further rigorous research with standardized protocols is needed to validate these results and guide clinical practice. Future investigations should aim for larger sample sizes and longer follow-up periods to thoroughly evaluate the effectiveness of VR in burn rehabilitation.
OBJECTIVES:Over-resuscitation is a formidable complication of burn resuscitation and increased morbidity and mortality. Currently, the Advanced Trauma Life Support recommends using a modified Brooke's formula to minimise its incidence; however, supporting evidence is very limited. We aimed to compare the resuscitative and clinical outcomes between the Parkland and modified Brooke's formulas in patients with burn trauma. METHODS:A retrospective cohort study was conducted through a chart review of patients admitted to the burn unit. The patients were divided into two groups: Group 1 (2017-2019) was resuscitated using Parkland's formula and Group 2 (2020-2022) with modified Brooke's formula. The main outcome measures were mortality rate, length of stay, complication rate exceeding the Ivy index (250 mL/kg) in the first 24 h, and overall fluid administered in the first 24 h. RESULTS:We included 125 patients, of whom fifty-five were resuscitated using Parkland's formula and seventy using the modified Brooke's formula. Patients in group 1 had higher resuscitation volume (5.04 vs. 3.37 mL/kg/total body surface area, P < 0.0001) and were more likely to exceed the Ivy index (250 mL/kg) (32.73% vs. 12.86%, P = 0.0074) in the first 24 h compared to those in group 2. There were no significant differences in clinical outcomes between the two groups. CONCLUSIONS:The modified Brooke's formula resulted in lower resuscitative volumes in the first 24 h than Parkland's formula, with no differences in complication rates. Our findings are consistent with currently recommended guidelines.
