Background

KAR™ prosthesis was introduced following the success of Corail® femoral stem to tackle difficult revision cases (Paprosky type1, 2a, 2b and 3a). The ARTO group reported a success rate of 94% at 17 years follow-up. Only two independent studies reported similar success rate to date.

Introduction:

Symptomatic treatment of ankle osteoarthritis (OA) with corticosteroid injections is well established. Hyaluronic acid is also reported as an effective symptomatic treatment for ankle OA but these two treatments have not been compared directly.

Background: Prior studies identified that crash severity (Delta V), occupant position, and restraint systems as reliable predictors of crash injuries.1–5 Others have noted that correlation between the biomedical thresholds (age, gender, height, weight) and injury pattern to the lower extremity but very little have been written on the subject of upper extremity.

METHOD: This is a retrospective analysis of CIREN database in a level trauma center focusing on upper extremity injuries. The aim was to investigate the relationship between of the ‘crash’ and ‘occupant’ factors on the pattern and severity of upper extremity injuries following a frontal impact collision. results &

Discussion:Majority of the injuries were soft tissues type. (67.6% soft tissue vs. 32.4% fractures). There were 144 fractures to the upper extremity, 12.5% were ‘open’ fractures. 66% of cases of fractures required operative intervention. 74.5% of the fractures sustained in the upper extremity occurred distal to the elbow, whereas soft tissue injuries predominated in the humerus. 21.5% of distal radius fractures were attributed to airbag deployment and all of the clavicle fractures were related to compression from seat belt. Occupants who sustained fractures had a significantly higher ISS scores (mean score 21.88 vs. 17.68, p < 0.05). Using logistic binary regression model, the ISS continued to be a significant predictor for fracture, overriding weight as a co-founding variable. Of the 144 fractures, 66% of cases required operative intervention.

Conclusion:. To advance occupant protection, it is important to understand the differences in individual variability in affecting injury tolerance in high-energy trauma. One could argue that current modern restraint systems are not designed to protect these vulnerable areas; therefore it may not come as a surprise to observe such an emerging trend of injuries to the upper extremities. There is no doubt that modern restraint systems have contributed to the overall decrease in mortality over the years. However, there are case series reported on the effect of airbag-related injuries to upper extremities as a consequence of its primary effectiveness. Our study reinforce the debate for a more ‘depowered’ airbag capable of saving lives yet simultaneously protecting the upper extremities from serious injuries.

Aim: To survey how acute, traumatic, first-time anterior shoulder dislocation (AFSD) is managed amongst trauma clinicians in the current clinical setting in UK hospitals.

Design: Postal Questionnaire.

Method: 228 questionnaires were sent out to list of active consultant member of the British Trauma Society practising in various hospitals around United Kingdom. Questions were laid out in two workgroups. In work-group one, an assortment of questions were asked with the emphasis on management in AFSD from the point of entry in a casualty department to departure and after-care. In workgroup two, case scenarios were included to look in the ‘aftercare’ management in three distinct age groups; young (< 25 years old), middle age (30–65 years old) and elderly (> 65 years old).

Results: The response rate of the questionnaires was 51%. Twenty-two per cent of respondents have local protocol for managing AFSD. All respondents recommended pre-and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia with ‘airways monitoring’, as opposed to intra-articular anaesthesia (68 versus 9). Kocher and Hippocrates were the most popular methods of reduction. Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only a small number of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury (16 of 84).

Conclusion: This survey revealed the current practice of trauma clinicians in managing AFSD on the ‘front-line’. We conclude that there is significant variation in response to the issues incorporated in this survey. There is a need to address the issues of intra-articular analgesia, immobilisation technique and management of AFSD amongst young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised controlled clinical trial prior to the introduction of a protocol for managing this problem.

Introduction: The annual fatalities from the road traffic accidents were relatively stable over the last decade. However over the same period there is noticeable shift in the effect of passenger vehicle rollover crashes on this total. This study looks into the injury characteristics in rollover car crashes utilizing the National Automotive Sampling System (NASS) database.

Aim: To describe the regional distribution of the injury pattern in the rollover crashes, and identify the main cause of death in fatal cases according to body region.

Methods: Retrospective analysis of the NASS database during the period of 1997–2002 was analysed. Only the car model from year 2002 was included in this study. The regional body distribution was classified as follows

Head and Neck

Thorax

Abdomen

Upper limbs

Lower limbs

The total number of occupants involved, age range of drivers, and detailed descriptions of the injuries sustained were described.

Results: There were total of 155 occupants involved in 88 roll over car crashes. The age range of the occupants was 7 months to 84 years. The drivers age range was 15 years – 84 years. There were 50 male drivers, and 38 female drivers. The body region most commonly involved was Head and neck followed by upper extremity. There were 33 fatalities and the main cause of fatality was injury to the brain, accounting for 54.5%.

The distributions of injuries were

Head and neck- 93 (60%)

Thorax- 37 (23.8%)

Abdomen-24 (15.4%)

Upper limbs- 73 (47%)

Lower limbs- 53 (34%)

Conclusion: Rollover crashes are becoming increasingly common due to increase demands of sport utility vehicles. There is a significant number of fatalities. Majority of the occupants sustained multiple injuries. However, the most common body region involved after roll over crashes was head and neck. The young male drivers are more vulnerable group. Improvement of the safety features in new vehicle design should take into account of this body region.