Distracted driving is now the number one cause of death among teenagers in the United States of America according to the National Highway Traffic Safety Administration. However, the risks and consequences of driving while distracted spans all ages, gender, and ethnicity. The Distractions on the Road: Injury eValuation in Surgery And FracturE Clinics (DRIVSAFE) Study aimed to examine the prevalence of distracted driving among patients attending hospital-based orthopaedic surgery fracture clinics. We further aimed to explore factors associated with distracted driving.

In a large, multi-center prospective observational study, we recruited 1378 adult patients with injuries treated across four clinics (Hamilton, Ontario, Toronto, Ontario, Calgary, Alberta, Halifax, Nova Scotia) across Canada. Eligible patients included those who held a valid driver's license and were able to communicate and understand written english. Patients were administered questions about distracted driving. Data were analyzed with descriptive statistics.

Patients average age was 45.8 years old (range 16 – 87), 54.3% male, and 44.6% female (1.1% not disclosed). Of 1361 patients, 1358 self-reported distracted driving (99.8%). Common sources of distractions included talking to passengers (98.7%), outer-vehicle distractions (95.5%), eating/drinking (90.4%), music listening/adjusting the radio (97.6%/93.8%), singing (83.2%), accepting phone calls (65.6%) and daydreaming (61.2%). Seventy-nine patients (6.3%), reported having been stopped by police for using a handheld device in the past. Among 113 drivers who disclosed the cause of their injury as a motor vehicle crash (MVC), 20 of them (17%) acknowledged being distracted at the time of the crash. Of the participants surveyed, 729 reported that during their lifetime they had been the driver in a MVC, with 226 (31.1%) acknowledging they were distracted at the time of the crash.

Approximately, 1 in 6 participants in this study had a MVC where they reported to be distracted. Despite the overwhelming knowledge that distracted driving is dangerous and the recognition by participants that it can be dangerous, a staggering amount of drivers engage in distracted driving on a fairly routine basis. This study demonstrates an ongoing need for research and driver education to reduce distracted driving and its devastating consequences.

Introduction Reflex sympathetic dystrophy (RSD) as a complication of total knee arthroplasty (TKR) is rarely mentioned. The literature has been limited to 58 cases of RSD in TKR, a prevalence of 0.8% of all TKR done. No previous reports give a clear understanding as what to expect in the long term after the diagnosis of RSD post TKR has been made nor do they report the struggle that patients undergo to achieve their result.

Methods We report on 11 cases of RSD diagnosed post TKR, operated on by one of us from 1991 to 2001. All patients met diagnostic criteria for Complex Regional Pain Syndrome, Type 1. Specifically they exhibited slow post-operative recovery and delayed return of normal function. Flexion was limited and cutaneous hypersensitivity was present along with temperature changes in the limb. These patients were evaluated using general and disease specific outcome tools previously validated in the literature, the SF-36 and WOMAC scores. In addition they were evaluated clinically at minimum two years following resolution of symptoms.

Results We found that once appropriate treatment had been instituted, which in our case was manipulation under anaesthetic in the painfree phase of CRPS-I, the majority of our patients reported higher scores on the bodily pain section of SF-36 however these were still lower than age matched controls of pre-operative osteoarthritic patients as determined by WOMAC scores. In general, though patients had poorer SF-36 and WOMAC scores than primary uncomplicated TKR, they did significantly better than primary osteoarthritics without surgery.

Conclusions This would suggest that when appropriately managed, RSD after TKR does not hold the dire prognostic consequences as previously thought.