Introduction.
Introduction: Fractured scapula is rare because the scapula is mobile and well protected. We report the first prospective study in the literature of scapular fractures caused by
Background /Methods: Abbreviated Injury Scale based systems; the ISS, NISS, and AISmax, are used to assess trauma patients. The merits of each in predicting outcome are controversial. A large prospective database was used to assess their predictive capacity using receiver operator characteristic curves. Results: 13,301 adult patients met the inclusion criteria. All systems were significant outcome predictors for sepsis, multiple organ failure (MOF), length of hospital stay, length of ICU admission and mortality (p 0.0001). NISS was a significantly better predictor than the ISS for mortality (p 0.0001). NISS was equivalent to the AISmax for mortality prediction and superior in patients with orthopaedic injuries. NISS was significantly better for sepsis, MOF, ICU stay and total hospital stay (p 0.0001). Analysis of the ROC curves revealed that the traditional ISS cut-offs for severity of 16, 25 and 50 should be increased to 20, 30 and 55 to provide patients with equivalent outcome. Conclusions: NISS is superior or equivalent to the ISS and AISmax for prediction of all investigated outcomes in a population of
Background: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in
Cervical extrication collars are frequently used in pre hospital stabilization and in the definitive treatment for lesions of the cervical spine. The control of extensionflexion, lateral bending, and rotation given to individual segments is variable with different designs.
There is evidence that fracture healing is delayed in severely injured patients. We recently demonstrated that a
The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
Background. Thoracolumbar fractures are the most common spinal injuries resulting from
Aim. The knee radiograph is a commonly requested investigation as the knee joint is commonly injured. Each radiograph exposes 0.01mSv of radiation to the patient that is equivalent to 1.5 days of natural background radiation. Also, each knee radiograph costs approximately £37.16 to produce. The aim of the clinical audit was to use the Pittsburgh knee rules to attempt to reduce the number of knee radiographs taken in patients with acute knee injuries and hence reduce the dose of ionising radiation the patient receives. Method. A retrospective audit was undertaken. 149 knee requests and radiographs taken during October 2016 were evaluated. Each knee radiograph request including patient history and clinical examination was graded against the Pittsburgh knee rules to give a qualifying score. The Pittsburgh knee rules assigns 1 point for each of the following;
Cryotherapy is often applied after injuries of synovial joints. Although positive clinical effects on periarticular swelling and pain are well known, the effects on molecular processes of cartilage and synovial cells remained largely unknown so far. Therefore, the hypothesis was tested that hypothermia alleviates the synovial reaction and prevents chondrocyte death as well as cartilage destructive processes after
Aims. The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after
Aims. Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures. Patient and Methods. This was a consecutive cohort study of 113 patients, who had sustained type IIIB fractures of the tibia following
Introduction: Road side accidents resulting in polytrauma with an associated fracture of femur is a common pattern of injury in asian countries. We hypothesised that the use of unreamed nailing in the management of such fractures has better outcome than reamed nailing. Material and Methods: We retrospectively reviewed 116 cases of polytrauma with associated fracture of shaft of femur admitted in our tertiary teaching hospital in North India bewteen Jan 1996 to Dec 2001. The patients were initially resuscitated according to the advanced trauma life support protocol. They were randomally managed by interlocking nail using reamed (n=48) and unreamed (n=68) technique after being haemodynamically stabilized. Five intraoperative parameters were recorded – the surgical time, fluoroscopy time, the intraoperative blood loss, intraoperative oxygen saturation, and any intraoperative complications. The patients were assessed postoperatively for ninety six hours for features of adult respiratory distress syndrome. All patients were clinically and radiologically assessed at 6 weekly intervals till union. The follow-up reassessments were performed by a single surgeon (AG). Results: There were 80 males, 30 females (6 were bilateral), with an average age of 26 years (range 19 to 64 years). The fractures were closed in 74 and open in 42 (Gustillo Grade 1;n=28, Grade 2;n=9, Grade 3;n=5). 48 were managed by reamed interlock nailing (Group 1) and 68 by unreamed interlock nailing (Group 2). 58 patients had an associated
Popliteal artery injury (PAI) is a feared complication
during knee replacement. Our aim was to investigate those injuries
that occurred in association with knee replacement in terms of the
type of injury, treatment and outcomes. From our national vascular registry (Swedvasc) and the Swedish
Patient Insurance databases a total of 32 cases were identified.
Prospective data from the registries was supplemented with case-records,
including long-term follow-up. We estimated the incidence during 1998 to 2010 to be 0.017%.
In our series of 32 patients with PAI occurring between 1987 and
2011, 25 (78%) were due to penetrating trauma and seven were caused
by
Rib fractures (RF) represent the most common bone fracture after
We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose
Introduction:. South Africa has a very sports orientated population and a high
We report the functional and socioeconomic long-term
outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre
between 1973 and 1990 with multiple
We studied 47 patients with closed, displaced, diaphyseal fractures of the femur caused by
Guidelines for cervical trauma x-rays highlight the necessity for visualization of the C7-T1 junction. However, despite 15% of thoracolumbar fractures involving the T12 vertebra, less emphasis has been placed on ensuring the thoracolumbar junction or T12 vertebra is included on lumbar trauma radiographs. This may be due to an assumption that the lower thoracic spine will routinely be seen on lumbar x-rays. We aimed to determine the proportion of lumbar trauma x-rays that allowed adequate visualisation for fracture diagnosis. We retrospectively reviewed all lumbar spine radiographs for patients presenting with
The early diagnosis of the suprascapular nerve (SSN) entrapment in overhead athletes with simultaneous shoulder injuries and its arthroscopic release plays an important role for their appropriate treatment and recovery. SSN release at suprascapular and spinoglenoid notches, seems very helpful for increasing their performance. 21 Elite overhead athletes were treated from Jan 2005–May 2009. From 16 to 34 years old, mean 26 years, 4 Javelin throwers (Olympic and National level thrower), 4 Weightlifters (International level), 8 Volleyball Players, 3 Kick Boxer, 2 Water Polo Players. Extreme ROM of arm creates large torques about the shoulder cycle of repetitive microtrauma to the SSN, Direct trauma: fracture, dislocation,
The conflict in Iraq has evolved from a conventional war in April 2003 to a guerrilla-based insurgency. We investigated whether this change altered the pattern of wounding and types of injuries seen in casualties presenting to a military field hospital. From January 2006 – October 2006, data was collected on all casualties who presented to the sole British field hospital in the region following injury from hostile action (HA). 86 casualties presented with injuries from hostile action (HA). 3 subsequently died of wounds (DOW – 3.5%). 46 (53.5%) casualties had their initial surgery performed by British military surgeons. 20 casualties (23.2%) sustained gunshot wounds, 63 (73.3%) suffered injuries from fragmentation weapons and 3 (3.5%) casualties sustained injury from
Traumatic disruption of the pelvic ring has a high risk of mortality. These injuries are predominantly due to high-energy,
Our aim was to investigate the incidence and outcome of chest injuries after
Study objective: To validate the Ottawa Ankle Rules (OAR) to predict significant fractures in a Danish clinical setting. Methods: We designed an interventional clinical study in the emergency department, Kolding Hospital. The intervention and control groups consisted of all patients presenting with a
Background: Neutrophil (PMN) infiltration of the lung is characteristic of ARDS. Interleukin-8 (IL-8) plays a central role in the recruitment of PMN to the lung and their subsequent activation. This study examines PMN migratory activity in response to IL-8, over the first 24 hours of admissions following major trauma. Methodology: Study Population: Adult
Introduction Open calcaneal fractures are high-energy compression injuries that commonly result in dismal outcomes, despite appropriate care. Fracture pattern associated with these compound injuries have never been documented in detail. Plain radiographic studies and CT are imaging modalities commonly utilized to assess the fracture patterns. Methods The roentgenographic studies of thirty-nine consectutive compound fractures treated at our University Hospital were retrospectively reviewed to evaluate fracture subtypes and incidence. Hindfoot roentgenograms were performed in all individuals; more than three-fourths of the fractures were also assessed with CT. Results A vast array of fracture patterns was noted with variable incidence. Over 90% were intra-articular fractures. Eighty-seven percent resulted from
Objectives: Behind armour
The anatomy of the prevertebral region of the neck is of vital importance to orthopaedic surgeons when managing cervical spine trauma. Lateral radiographs are used in the acute assessment of this area as they are readily available and cost effectiveness. Thickening of the retropharyngeal space on a radiograph may be highly suggestive of serious and life-threatening pathologies. Accurate interpretation of radiological evidence is essential to assist the clinician in diagnosis. Current guidelines for radiological measurement state that these prevertebral soft tissues should not exceed 5mm at the midvertebral level of C3 and 20mm at C7. A ratio between soft tissue measurements and the width of the corresponding vertebra has also been championed as this takes into account magnification errors and variation in patient body habitus. Soft tissue measurements greater than 30% of the upper cervical vertebral bodies and greater than 100% of the lower cervical vertebral bodies are considered to be abnormal. The aim of this study was to assess reliability of current radiological guidelines on soft tissue measurement. A review of 200 consecutive normal lateral soft tissue cervical spine radiographs was undertaken. Patients were included if they were immobilised for
All patients over 65 yrs with an ISS greater than 15 attending Edinburgh Royal Infirmary between 1997 and 2000 were prospectively entered into the study. Patients were followed until death or discharge home. The patients were divided into, group 1 [patients who survived], and group 2 [those who died.]. A total of 72 patients were included in the study, 42 males and 31 females. 42 patients survived, and 31 died. Group 1 consisted of 29 males and 15 females with an average age of 75.23yrs. Group 2 consisted of 13 males and 18 females with an average age of 78.05yrs. All incidents involved
Acute Respiratory Distress Syndrome (ARDS) is a rare but important complication of trauma, with a mortality of around 50%, and considerable morbidity amongst survivors. The treatment options currently available are supportive only. Although trauma is known to be an important risk factor, previous studies have been intensive care-based and the epidemiology of ARDS amongst trauma patients remains unknown. We prospectively studied 7387 consecutive admissions to a single University Hospital, providing all trauma care to a well defined population, over an eight year period. Inclusion criteria were admission following trauma, age over thirteen and residence within the catchment area. Fifty five percent of all patients studied were male, the average age was fifty years and 97% of injuries were due to
We performed a retrospective review of the case notes of 84 consecutive patients who had suffered a severe (Gustilo IIIb or IIIc) open fracture of the tibia after
Traumatic central cord syndrome (CCS) typically follows a hyperextension injury and results in motor impairment affecting the upper limbs more than the lower, with occasional sensory impairment and urinary retention. Current evidence on mortality and long-term outcomes is limited. The primary aim of this study was to assess the five-year mortality of CCS, and to determine any difference in mortality between management groups or age. Patients aged ≥ 18 years with a traumatic CCS between January 2012 and December 2017 in Wales were identified. Patient demographics and data about injury, management, and outcome were collected. Statistical analysis was performed to assess mortality and between-group differences.Aims
Methods
Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This cohort study included patients with severe open tibial fractures from the Trauma Audit and Research Network (TARN). Provision of prompt surgery (debridement within 12 hours and soft-tissue coverage in 72 hours) was examined, using multivariate logistic regression to derive adjusted risk ratios (RRs). Time was categorized into three eight-hour intervals for each day of the week. The models were adjusted for treatment in a major trauma centre (MTC), sex, age, year of presentation, injury severity score, injury mechanism, and number of operations each patient received.Aims
Methods
Confirming clinical evidence, we recently demonstrated in a rodent model that a severe trauma which induces an acute systemic inflammation considerably impairs fracture healing. Interleukin-6 (IL-6) is a key cytokine in posttraumatic inflammation as its serum level correlates with injury severity and mortality. IL-6 signals are transmitted by the transmembrane glycoprotein 130 (gp130) via two distinct mechanisms: firstly, through classic signalling via the membrane-anchored IL-6 receptor and secondly, through trans-signalling using a soluble IL-6 receptor. Whereas IL-6 trans-signalling is considered a danger signal driving inflammation, classic signalling may mediate anti-inflammatory, pro-regenerative processes. The role of the two distinct pathways in bone healing has not yet been elucidated. Here, we studied the function of IL-6 in the pathophysiology of compromised bone healing induced by severe trauma. Male C57BL/6J mice received an osteotomy of the right femur stabilized with an external fixator. Systemic inflammation was induced by additional
This study estimated trends in incidence of open fractures and the adherence to clinical standards for open fracture care in England. Longitudinal data collected by the Trauma Audit and Research Network were used to identify 38,347 patients with open fractures, and a subgroup of 12,170 with severe open fractures of the tibia, between 2008 and 2019 in England. Incidence rates per 100,000 person-years and 95% confidence intervals were calculated. Clinical care was compared with the British Orthopaedic Association Standards for Trauma and National Major Trauma Centre audit standards.Aims
Methods
The aim of this study was to determine the fracture haematoma (fxH) proteome after multiple trauma using label-free proteomics, comparing two different fracture treatment strategies. A porcine multiple trauma model was used in which two fracture treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). fxH was harvested and analyzed using liquid chromatography-tandem mass spectrometry. Per group, discriminating proteins were identified and protein interaction analyses were performed to further elucidate key biomolecular pathways in the early fracture healing phase.Aims
Methods
Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature. A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale.Aims
Methods
Purpose of study:. The presence of an L5 transverse process fracture is reported in many texts to be a marker of pelvis fracture instability. There is paucity of literature to support this view. Available studies have been performed on patients who were already known to have a pelvis fracture. No study has attempted to document the presence of this lesion in the absence of a pelvis fracture. Primary aim: To identify the correlation between the presence of a L5 transverse process fracture and an unstable pelvic ring injury. Secondary aim: To establish whether a L5 transverse process fracture can occur in the absence of a pelvis fracture. Methods:. We conducted a retrospective review of all CT scans performed in patients who presented to a Level 1 Trauma Unit for
Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p < 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL.Aims
Methods
Pelvic x-ray is a routine part of the primary survey of Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard in the diagnosis of pelvic fractures. This study aims to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis, in favour of later pelvic CT scan. A retrospective analysis of polytraumatized patients in our emergency room was conducted between 2005 and 2006. Inclusion criteria were
Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland. A retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location.Aims
Methods
Objective: To assess the impact of EPP on physiological parameters in hemodynamically unstable patients with
The purpose of this prospective study was to assess the patient referrals to King Edward V111 hospital with respect to communication, quality of referral letters, transfer times, investigations, diagnostic accuracy, initial management, associated and missed injuries. 88 Patient referrals were assessed prospectively over 4 months by a single investigator utilizing a questionnaire. The average age was 41 years. Eighteen (20%) were compound fractures. The average transfer time of closed injuries was 10h08 and compound injuries 4h20. 20 Patients (23%) were not discussed prior to transfer and 1 (1%) patient did not present with a referral letter. Referring physician details were deficient in name 10 (11%), contact details 58 (66%) and designation 82 (93%). No receiving physician was listed in 23 (26%) referrals. Mechanism of injury was provided in 51 (58%) referrals, time of injury in 41 (47%), type of splinting in 53 (60%) and type of analgesia in 11 (12%) referrals. Referrals of compound fractures showed a description of wound care in 11 (61%) referrals, antibiotic therapy in 9 (50%) and tetanus prophylaxis in 3 (16%). 53 (60%) referrals presented without haematological investigations and 84 (95%) presented with radiological investigations of which 54 (64%) were inadequate. Splinting was satisfactory in 35 (40%) and analgesia was adequate in 9 (10%). Wound care was appropriate in only 5 (27%) and antibiotics were administered in 7 (39%) compound fractures. Diagnostic errors emerged in 14 (16%) of referrals with a missed injury rate of 10% (9 pts). 1 Patient required urgent intervention due to
Edema and infection represent serious complications of
Adult polytrauma patients are at high risk of developing acute lung injury. Fat embolism or traumatic pulmonary contusions are the usual causes and respiratory support is often indicated. Conventional treatment with intubation and positive pressure ventilation is sufficient for most patients with moderate lung injury. However, for patients with acute severe respiratory failure who remain hypoxic despite maximal pressure ventilation, the mortality rate exceeds 60%. We have reviewed the use of extracorporeal membrane oxygenation (ECMO) in adult trauma patients with acute severe respiratory failure. ECMO was performed at a tertiary unit in an intensive care setting. Using an external oxygenation circuit the injured lungs were “rested” until pulmonary function recovered. With this method ventilation pressures could be reduced and ventilator-related pulmonary barotrauma was limited. Between 1992 and 2000, 28 adult trauma patients were referred for ECMO. This group of patients were at the severe end of the ARDS spectrum with an average Murray Lung Injury score of 3.2. The most common injuries included long bone or pelvic fractures, and
Background: Autologous mesenchymal stem cells (MSC) have been shown to improve the functional outcome after severe skeletal muscle trauma. The reasons for this improvement have yet not been revealed. Up to now insufficient techniques of cell labelling, which could only be used for histologic analysis ex vivo, have been a problem. The development of iron oxide nanoparticles, which are taken up and endosomally stored by stem cells, allows the evaluation of cellular behaviour in the muscle with the use of magnetic resonance imaging (MRI). Previous work has shown that labelling does not affect the proliferation and neurogenic differentiation capacity of embryonic stem cells. In the present study we are currently investigating the in vivo distribution and migration of locally transplanted MSC after
The purpose of this retrospective study was to investigate the
clinical relevance of increased facet joint distraction as a result
of anterior cervical decompression and fusion (ACDF) for trauma. A total of 155 patients (130 men, 25 women. Mean age 42.7 years;
16 to 87) who had undergone ACDF between 1 January 2001 and 1 January
2016 were included in the study. Outcome measures included the Neck
Disability Index (NDI) and visual analogue scale (VAS) for pain.
Lateral cervical spine radiographs taken in the immediate postoperative
period were reviewed to compare the interfacet distance of the operated
segment with those of the facet joints above and below.Aims
Patients and Methods
Little is known about the effect of haemorrhagic shock and resuscitation
on fracture healing. This study used a rabbit model with a femoral
osteotomy and fixation to examine this relationship. A total of 18 male New Zealand white rabbits underwent femoral
osteotomy with intramedullary fixation with ‘shock’ (n = 9) and
control (n = 9) groups. Shock was induced in the study group by
removal of 35% of the total blood volume 45 minutes before resuscitation
with blood and crystalloid. Fracture healing was monitored for eight weeks
using serum markers of healing and radiographs.Aims
Materials and Methods