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At least 289 records · Page 16Linked to original sources

PubMed2004

Pre-hospital and hospital traumatic deaths in the former homeland of Transkei, South Africa.

This retrospective descriptive study on 274 medicolegal cases was to determine the issues related to pre-hospital and hospital deaths in injured patients and to determine whether any of the deaths were preventable in the area. Interviews of the family members were conducted individually before carrying out autopsies. Time of survival after trauma, place of death, and the cause of death were recorded along with the demographic information -- age, sex, occupation, and personal habits. Umtata General Hospital in the Eastern Cape Province is the referral hospital for a surrounding population of about 400,000. Seventy four percent (74%) of the victims had been declared, 'presumably dead' at the scene by the community or police, and taken to mortuary without any death certification by a physician. The rest (26%) were taken to hospital where later they succumbed to trauma. Out of these only 4% underwent surgery. The majority (68%) of the victims were young ( < 40 years). The causes of deaths were: motor vehicle accidents (MVA) 32%, gunshot 24%, stab injury 17%, blunt trauma 9% and miscellaneous (fall from height, burns, etc.) 17%. Head and chest injuries were the commonest 50%. Only 17% survived from days to weeks. About 75% subjects died within 6 h of the trauma. There is a very high pre-hospital (74%) mortality of trauma patients in the Transkei region. The fact that members of the community or police and not a medical practitioner confirmed deaths raises the ethical issue of right to life. Some may actually be alive when they are considered dead. As it appears that 12% of pre-hospital deaths are preventable, employing more medical personnel in the rural areas along with an effective ambulance service would seem to be required.

Accidents, Traffic↗

PubMed2005

The use of free fibular flap for functional mandibular reconstruction.

PURPOSE: The purpose of this investigation is to document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the mandible, after combined resections of malignant and aggressive odontogenic tumors, with special emphasis on functional aspect of the reconstruction process. MATERIALS AND METHODS: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the fibular vascularized free flap, between 1997-2002. All procedures were performed in the same hospital and by the same surgical team. RESULTS: A total of 13 patients (9 males, 4 females) were treated in our department in a period of 6 years for reconstruction of discontinuity mandibular defects using the free fibula vascularized flap. Wound healing disturbances at the donor site occurred in 4 cases. Two flaps were lost, 1 because of total failure in a patient who was heavily irradiated because of osteosarcoma, the other because of resorption of the bone tissue transfer in a case of total avulsion of the mandible caused by a fall from height. CONCLUSION: Fibula free vascularized flap is a safe and reliable method for comprehensive functional and esthetic mandibular defect reconstruction. Our protocol has a significant impact on preserving the patients quality of life.

Adolescent↗

PubMed1996

Surgical treatment of patients with open tibial fractures.

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.

Accidents↗

PubMed1996

Traumatic rupture of the descending thoracic aorta.

Traumatic rupture of the descending thoracic aorta is a highly lethal injury caused by sudden, rapid deceleration in high-speed motor vehicular collisions and falls from heights. Deceleration causes the mobile ascending aorta and aortic arch to move forward while the descending thoracic aorta remains fixed by the mediastinal pleura. This opposing movement creates a tear at the aortic isthmus just distal to the origin of the left subclavian artery. Patients with traumatic ruptured descending thoracic aortas often have serious multisystem injuries, and approximately 85% of these patients die at accident scenes or during emergency department resuscitation. The most frequent cause of death is free rupture of periaortic tissues that temporarily have provided tamponade to the sites of aortic ruptures. Surgical mortality rates for patients who survive initial resuscitation are between 10% and 25%. Advances in field triage and emergency medical transportation systems and new preoperative evaluation modalities have improved the survival of patients with traumatic descending thoracic aorta ruptures.

Adult↗

PubMed1999

Occupational injuries in Shunde City--a county undergoing rapid economic change in southern China.

A survey was carried out in Shunde City of Southern China to look into the occurrence of occupational injuries in the 'township industries' during the years 1989-1993. A total of 981 major injuries and 159 fatal injuries were recorded for 602,533 person years over the 5 years, giving a major injury rate of 1.63/1000 per year and a fatal injury rate of 0.26/1000 per year. Both the major injury rate and the fatal injury rate increased from 1989 to 1993. Males had a higher fatal injury rate while females had a higher major injury rate. The majority of the injuries occurred in the younger age group with the 20-29 age group taking up more than half of the total casualties. Industries having high injury rates included building and construction, furniture, paper mill and printing. Electrical appliances manufacturing, sewing and shoe making were the industries having low injury rates. Enterprises with foreign capitals and those managed by individuals also had lower injury rates. Machinery injuries were the most common type of major injuries while electrocution, being hit by heavy objects and falling from height accounted for over 60% of fatal injuries. The implications of the differential distributions of the occurrence of the injures were discussed.

Accidents, Occupational↗

PubMed2002

Fractures of the neck of femur in children: an experience at the Aseer Central Hospital, Abha, Saudi Arabia.

The Orthopaedics Unit of Aseer Central Hospital, Abha, Saudi Arabia became fully operational in 1992. From then till 1999, 14 cases of fractures of the neck of femur in children under the age of 16 years were studied. The aims of the study were to compare our experience with those of other institutions and to serve as a reference point in this region for future study of this rare but disabling condition. The case notes of all the patients aged less than 16 years with fractures of the neck of femur managed at the Aseer Central Hospital between 1992 and 1999 were analysed retrospectively. Information obtained included age, sex, type of fracture, management, outcomes and complications. There were 14 children. The age range between 4 and 16 years (mean = 9.1 +/- 3.8 years). Male to female ratio was 1:1.3. Eight cases (57.1%) were due to road traffic crashes and 6 (42.9%) were due to falls from height. Six cases (42.9%) were of Delbet type II (transcervical) fractures, 5 cases (35.7%) were of type III (cervicotrochanteric), and 3 cases (21.4%) were of type IV (intertrochanteric) fractures. There was no case of Delbet type I (transepiphyseal separation). Patients were treated either surgically by reduction and internal fixation or conservatively by traction followed by hip spica cast application. Avascular necrosis occurred in 7 cases (50.0%). Only 3 cases of partial avascular necrosis were seen and all the 3 improved. The rest 4 (28.6%) had collapse of the femoral head. In only 2 cases (14.3%) of femoral neck fracture, the patients did not have any associated injuries. While fracture of neck of the femur is rare in children, the high incidence of complications that can lead to life-long disability makes it an important clinical entity.

Adolescent↗

PubMed2004

A study of 13 cases of near-hanging presenting to an Accident and Emergency Department.

This paper reports 13 cases of near-hanging presenting to the Accident and Emergency (A + E) Department of a District General Hospital over a 52-month period. The purpose of the study was to analyse the epidemiology, methods, outcomes and complications of near-hanging. There were 13 cases in the study period, 12 of whom were male and 1 female. The mean age was 31 years. The most common method used was rope (five cases). The estimated mean duration of hanging was 5 min. Height of fall data was poorly recorded but only one fall was recorded as being more than 3 ft. Many had a very poor clinical picture on arrival of the ambulance crews: seven had a Glasgow Coma Score (GCS) of less than or equal to 8 on scene, of which five required intubation. Five patients required ventilation and a period of treatment on the Intensive Therapy Unit (ITU). There were no cervical spine (C-spine) injuries, nor neurological complications. There were two incidences of aspiration pneumonia. All of the patients made a full recovery. It is concluded that patients presenting with this injury go on to make a full recovery, despite an often dismal initial clinical picture.

Adult↗

PubMed1987

Blunt cardiac injury in children.

Thirty-nine children admitted to the pediatric intensive care unit with multiple injuries from blunt trauma underwent serial EKGs, determination of creatinine phosphokinase (CPK) isoenzymes, echocardiography, and radionuclide angiography studies. Motor vehicle injuries were responsible for 83% (32 of 39) of admissions, the remainder (7 of 39) caused by falls from heights. Thirteen children sustained serious (Modified Injury Severity Score [MISS] greater than 25) multiple system injury. Chest injuries were sustained by 12 children, nine being serious thoracic injuries (MISS chest score greater than 2). Three children (7.7%) showed elevations of MB fraction of CPK isoenzymes in addition to EKG abnormalities and/or ejection fraction depression on radionuclide angiography and were considered to have sustained cardiac contusion. Eight other children (20%) had normal or borderline elevation of CPK-MB fraction and EKG abnormalities combined with abnormal echocardiograms or radionuclide angiograms, and were considered to have sustained cardiac concussion. An additional 14 children (36%) had EKG or radionuclide angiography abnormalities alone. Two children required lidocaine therapy for cardiac irritability manifesting as multifocal PVCs and ventricular tachycardia. Based on this study, a comprehensive diagnostic evaluation of the heart in all children sustaining multiple injuries from blunt trauma cannot be justified. Continuous cardiac monitoring should be initiated in the emergency room and maintained throughout intensive care unit confinement to identify transient dysrhythmias. In patients with significant dysrhythmias and in those with obvious thoracic injuries serial EKG and cardiac isoenzyme assay should be obtained. Dysrhythmias should be man-aged with appropriate anti-arrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Posterior urethral disruption secondary to a penetrating gluteal injury.

We report a case of a complete posterior urethral injury secondary to a penetrating gluteal injury. Posterior urethral injury usually occurs in male patients with pelvic trauma. The reported incidence of urethral injury with pelvic fracture ranges from 1.6% to 25% (mean 10%), with 66% of them being complete posterior urethral ruptures. Causes of posterior urethral disruptions include blunt trauma, such as occur in road traffic accidents or falls from heights, and high velocity penetrating and crush injuries. Penetrating gluteal injuries that cause posterior urethral damage are extremely rare. This report presents the first case of a complete urethral injury due to a gluteal stab wound. Furthermore, this case demonstrates that any sign of injury to the lower urinary tract, regardless of the cause or weapon implicated, warrants an immediate evaluation.

Adult↗

PubMed1994

Emergency department analgesic use in pediatric trauma victims with fractures.

STUDY OBJECTIVE: To investigate the frequency of emergency department analgesic use in children with presumably painful fractures who are also at risk for associated multiple injuries and to determine whether there are specific factors that distinguish those who are prescribed analgesics from those who are not. DESIGN: Descriptive, retrospective review of a computerized trauma registry. SETTING: Regional pediatric ED and trauma center. PARTICIPANTS: Four hundred thirty-three injured children met trauma team activation criteria from January 1, 1991 through June 30, 1992. Of these 433, we selected the 121 children who had fractures of the pelvis, long bones, ankle, wrist, or clavicle. Of these 121, we excluded the 22 children who underwent endotracheal intubation. Trauma registry data from the prehospital and ED phases of care from the remaining 99 children were reviewed for this study. INTERVENTIONS: None. MAIN RESULTS: Of the study group, 53% (52 of 99) received analgesics, all narcotics. Excluding the 46 children with multi-system injuries, only 62% (33 of 53) received analgesics. Patients in both the analgesic (52) and no-analgesic groups (47) were mildly to moderately injured based on initial ED trauma scores and vital signs. No statistical or clinical significant differences were found between the analgesic group and the no-analgesic group when comparing age, sex, race, mechanism of injury, vehicle speed, height of fall, time elapsed from injury until arrival at the ED, transport method, prehospital analgesic use, mortality, Injury Severity Score, and initial ED vital signs, Glasgow Coma Scale, Trauma Score, and Pediatric Trauma Score. Fifty-nine percent (ten of 17) of the children with associated internal injuries limited to the chest or abdomen received analgesics compared with 62% (33 of 53) in those with isolated fracture (P = .8). Those with an associated head injury (31%, nine of 29) received analgesics less frequently than those with isolated fracture (62%, 33 of 53) (P = .01). CONCLUSION: Our results suggest that ED analgesic use was low in these mildly to moderately injured children with presumably painful fractures who are also at risk for associated multiple injuries. Head injury was associated with especially low analgesic use. We did not identify other specific factors that distinguished those who received analgesics from those who did not. Further investigation is required to determine if after the initial evaluation, a larger proportion of mildly to moderately injured trauma victims with fractures are appropriate candidates for ED analgesic use.

Adolescent↗

PubMed2001

Traumatic and iatrogenic lesions of the trachea and bronchi.

OBJECTIVE: The traumatic lesions of the trachea and the main bronchi appear to be rare, but as complications of the severe chest and neck injuries they require urgent surgical treatment. Unfortunately for the last few years the incidence of such traumas has increased. METHODS: During the last 15 years we have treated 28 patients (20 male and eight female) with traumatic lesions of the tracheobronchial tree aged from 8 to 64 years. The tracheal lesions were predominantly iatrogenic caused by difficult endotracheal intubation. The lesions of the bronchi (12 of the main and three of the lobar) were caused mainly by blunt traumas (car accidents and falling from heights). Total disruption of the right main bronchus was observed in five cases and of the left main bronchus - in seven cases. Emergency operative treatment was performed in all patients within 6 to 12 h after the incident. Cervical approach was performed in eight patients and postero-lateral thoracotomy in the other cases. RESULTS: We had one death in the early post, which was due to a severe trauma. Excellent and good results were obtained in 27 patients, which recovered well within 3 months and were followed up for periods ranging from 1 to 10 years. CONCLUSION: The traumatic lesions of the trachea and main bronchi require emergency surgical treatment. The proper choice of operative approach is largely dependent on the precise early diagnosis and on the determining of the exact location of the lesions. Operative tactics must aim at optimal preservation of the functional lung parenchyma and have to include reconstructive and plastic procedures.

Adolescent↗

PubMed2002

Injury biomechanics for aiding in the diagnosis of abusive head trauma.

Much of what is understood as potential for injury is based in what has been observed clinically. This knowledge base is critical for decision making but has inherent and important limitations. Experimental studies investigating the influence of environmental factors, such as height of fall and surface type on injury potential, add important information, but also have inherent limitations. Important trends and predictions of probable injury can be studied but inference to a specific child's injuries is difficult because of unaccounted for contributing factors of injury risk. Such factors include muscle contraction, protective reflexes, and specific tissue response to trauma forces. Additional biomechanical research is needed to bridge the gap between clinical observations and experimental predictions. The specific and unique perspective of the neurosurgeon is a critical piece in differentiating accidental and nonaccidental head injury with experience and reason as the basis of the conclusion. Do the physics of the injury match the mechanistic principals of the described injury event? Could all of the injuries result from the event? Is it plausible that these set of injuries occurred from the described event based on the [table: see text] physician's experience and the current scientific understanding of injury biomechanics? Do the mechanical forces of the reported mechanism and injuries match? To determine that an explanation is plausible requires consideration of all the facts and injuries, consideration of the described behavior, and consistency with the neurologic status. These facts of the case are compared with medical knowledge and the learned experience of the neurosurgeon. The answer to the question "is it possible?" is based on clinical experience and objective reasoning. Rather than a black box question and answer based in unrealistic probability, the answer is based on the facts of the case and physical principles that govern biomechanics and resultant injuries.

Biomechanical Phenomena↗

PubMed2003

[Growing skull fracture in childhood. Presentation of 12 cases].

Growing skull fractures (GSF) are rare complications of head injury (HI) in childhood. This entity consists of a skull fracture with an underlying dural tear that courses with a progressive enlargement of the fracture to produce a cranial defect. The pathophysiology and some aspects of its management are still controversial. In this review we present 12 patients diagnosedd and treated for a GSF at our institution between 1980 and 2002. 11 patients were under the age of 3 years and one patient was 5 years old at the moment of HI. The most common cause of injury was a fall from height. In the initial plain x-rayfilms, 11 patients showed a diastatic skull fracture and one patient only had a linear fracture. At this time, CT scan showed cortical contussion underlying the fracture in every case. The mean time between injury and presentation of GSF was 11.6 weeks. Diagnosis was made by palpation of the cranial defect and confirmed with skull x-rayfilms. The most frecuent location of GSF was in the parietal region. Associated lesions like hydrocephalus, encephalomalacia, lepto-menigeal cysts, brain tissue herniation and ipsilateral ventricular dilatation, were found in the preoperative CT or MRI. All patients underwent a dural repair with pericranium or fascia lata. The cranial defect was covered with local calvarial bone fragments in every case. Only one patient needed a cranioplasty with titanium mesh. Every child with a skull fracture must be followed until the fracture heals. Patients under the age of 3 years with a diastatic fracture and a dural tear, demostrated by TC or MRI, are more prone to develop GSF. In these cases, early repair must be adviced in order to prevent progressive brain damage.

Child, Preschool↗

PubMed1978

Spinal injuries in Rangoon, Burma.

Spinal injuries in Burma as a result of a fall from height, especially from trees, in young male adults in low socio-economic classes; road traffic accidents are the second commonest cause; deep vein thrombosis and pulmonary embolism is very rare during the period of immobilisation. There are still some social problems of getting back to work and living conditions. We are trying our best to help the patients with spinal injuries.

Accidents, Occupational↗

PubMed1983

Paraplegia in women.

In the period 1965-80, 125 women were treated because of paralysis or paresis of the lower extremities resulting from spinal trauma. In this report the causes of trauma, as well as the clinical and functional treatment of this group are discussed. The most frequent causes of trauma were falls from heights, from a tree, a ladder, a horse-cart as well as suicidal jumps and road accidents. It was ascertained that the results of treatment of spinal cord injuries in the upper thoracic segment are worse than in its lower part. These results do not differ from men with similar degrees and neurological levels of spinal cord injury. On the other hand the duration of treatment is longer in women than in men with the same degree of spinal cord lesion, amounting on the average to 17.4 weeks.

Adult↗

PubMed1992

Traumatic injury to the spinal cord. Prevalence in Brazilian hospitals.

Traumatic spinal cord lesions have a worldwide high morbidity and mortality, and in many developed countries the problem has received special attention, based on epidemiological studies. In Brazil these studies have been restricted to institutional data. In 1988 a survey conducted by the Integrated System of Traumatology and Orthopaedics, covering 36 public hospitals from 7 Brazilian capitals, revealed a point prevalence of 8.6% (108 patients) with spinal cord injury, aged from 6-56 years; 81% were men. The most frequent causes were traffic accidents (42%), firearms (27%) and falling from heights (15%). The main complications were pressure ulcers (54%) and urinary infections (32%).

Adolescent↗

PubMed1994

Epidemiology of spinal cord injuries: a reflection of changes in South African society.

The records of all patients (492 males and 124 females) admitted into a spinal rehabilitation programme over a period of 6 years were reviewed. Most of the patients were in the age group 20-29 years and trauma accounted for 89% of all spinal cord lesions. Gunshot injuries were the commonest (36%), followed by injuries related to motor vehicle accidents (MVA) (25%), stab wounds (20%) and falls from heights (2.4%). Aetiological patterns changed over the 6 year period covered: gunshot injuries increased markedly and stab wounds decreased in number. The records of a medico-legal laboratory in the same geographic region revealed the same trend. Neurological recovery rates were better in patients with stab wounds and nontraumatic lesions than in those with MVA-related injuries and gunshot wounds. When compared to similar studies from other countries, our results show a disproportionately high incidence of violent injuries, particularly gunshot wounds, in South African plegic patients. We concluded that the recent sociopolitical changes and especially the general escalation of violence in the country, is reflected in the observed changes in the epidemiology of spinal cord injuries.

Accidents, Traffic↗

PubMed2005

Ocular and visual complications of head injury.

PURPOSE: To evaluate the pattern of ocular and visual complications of head injury. METHOD: A prospective study of 225 head-injured patients managed at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. For the purpose of extracting visual complications, a Neurosurgeon and an Ophthalmologist examined each patient and appropriate investigations were carried out. Patients with ocular morbidity were analysed for age, sex, cause of injury, admission Glasgow coma score, and associated injuries in addition to findings at ophthalmic and neurosurgical evaluations. RESULTS: Two major types of ocular and visual complications were observed in 57 (25.3%) of 225 head-injured patients studied. Soft-tissue injury to the globe and adnexae included periorbital ecchymosis, subconjuctival haemorrhage, lid laceration, or rarely globe rupture in 29 patients. Neuro-ophthalmic ocular cranial nerve palsies occurred in 28 patients, while orbital fracture was encountered in two patients. Ocular injuries were multiple in 60% of cases. The patients, comprising 37 male and 20 female subjects, were aged 9 months to 57 years (mean=28 years). Traffic accident was the leading cause of head injuries (84.2%), while fall from height (7%), assault (7%), and gunshot (1.8%) were miscellaneous causes. CONCLUSION: Injury to the globe and adnexae and ocular cranial nerve palsies constitute the most common oculovisual complications following head injury in our centre.

Accidents, Traffic↗