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PubMed2004

Work-related injury sustained by foreign workers in Singapore.

INTRODUCTION: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). MATERIALS AND METHODS: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. RESULTS: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P < 0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. CONCLUSION: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised.

Accidents, Occupational↗

PubMed2004

[Cervical spine injuries in children].

Cervical spine injuries in children and adolescents are rare. Common mechanisms include motor vehicle accidents, sports injuries, fall from height, and gunshot injuries. Cervical spine injuries are classified by Allen and Ferguson according to the period they occur, as infantile, early juvenile, and late juvenile. Anatomically, two main types are defined as occipitoatlantal (upper cervical) and subaxial injuries. The purpose of this paper is to review cervical spine injuries in children and adolescents with respect to epidemiology, injury mechanisms, diagnosis, clinical and radiologic aspects, and treatment in the light of the current literature.

Adolescent↗

PubMed2004

Cauda equina syndrome in patients with low lumbar fractures.

OBJECT: Symptoms of cauda equina syndrome (CES) can include low-back pain, sciatica, lower-extremity weakness, sensory deficit, perineal hypesthesia or anesthesia, and loss of bowel or bladder function. Several causes of the syndrome are recognized, but its optimal treatment remains controversial and has been broadly based on data gathered from series involving herniated discs. Information on the treatment of CES caused by low lumbar traumatic injuries has not been well documented. METHODS: Between January 2000 and December 2003, 17 consecutive cases of CES caused by low lumbar traumatic injuries at L2-5 were identified. The traumatic injuries consisted of gun shot wound in two cases, motor vehicle accident in 11, and a fall from height in four. Conus medullaris injuries causing CES were excluded from this review. Presenting symptoms, mechanisms of injury, radiographic images, timing of surgery, surgical approaches, and neurological status at the final follow up were documented. All patients underwent follow up of at least 12 months. Fourteen of 17 patients had satisfactory outcomes. Despite undergoing surgery within the first 24 hours postinjury, three patients had what was classified as a poor outcome given their residual deficits and included two cases with gunshot injuries. Recovery of leg weakness occurred within 4 months, whereas bladder and bowel function recovered within 3 months. All patients in this series underwent decompression within less than 48 hours after syndrome onset. Overall, the authors found no difference regarding timing of surgery between patients in the satisfactory outcome group and those in the poor outcome group. CONCLUSIONS: Based on the evidence in this study, the severity of a patient's condition on initial presentation is the most crucial factor in predicting outcome following CES due to low lumbar injuries. Although the matter of the timing of surgery remains controversial, the authors of this study recommend that surgery be performed within 48 hours of syndrome onset.

Adolescent↗

PubMed2006

[Evaluation of surgical methods in patients with blunt liver trauma].

BACKGROUND: We evaluated the surgical methods, morbidity and mortality in patients who had surgery for blunt liver trauma. METHODS: We retrospectively reviewed 159 patients (116 males, 43 females; mean age 33.6; range 15 to 67 years) with blunt hepatic trauma regarding the cause and severity of liver injury, diagnostic procedures, associated injuries, management, morbidity, and mortality. Simple hepatorrhaphy was done in minor liver injuries (Grade I, II). To manage severe liver trauma (Grade III-V), debridement, selective hepatic artery ligation and omentum packing of the laceration (DSO) in 40; resectional debridement (RD) with direct control of bleeding vessels within the liver by the Pringle maneuver in 12; deep matress suture (DMS) in 23; and perihepatic packing (PP) in 9 patients were performed. RESULTS: The causes of trauma were motor vehicle accidents in 102, falls from height in 43 and violence induced blunt trauma in 14 patients. Among 159 patients, 84 had severe liver injuries and 75 had minor liver injuries. Associated organ injuries were present in 104 patients and splenic injury was the most common. Mean units of blood transfusions in DSO, DMS, RD and PP were 4.3, 6.2, 5.5 and 9.5 respectively. Mean time for liver surgery in DSO, RD, DMS and PP were 34.7, 38.1, 26 and 18.2 minutes respectively. Morbidity rate was higher in DMS group than in DSO and RD groups, and the difference was statistically significant (p<0.001). Twenty-five patients (29.4%) died of severe liver injuries and 9 (12%) died of minor liver injuries. The overall mortality rate was 21.3%. CONCLUSION: DSO, and RD methods don't increase operation time and amount of blood transfusion. They cause less morbidity and mortality when compared to DMS.

Abdominal Injuries↗

PubMed2005

[Evaluation of vertebral fractures and associated injuries in adults].

OBJECTIVES: We evaluated vertebra fractures and associated injuries in adults to determine the profile of patients presenting with a trauma etiology. METHODS: The study included 372 patients (264 men, 108 women; mean age 30.4 years; range 18 to 65 years) who were treated for vertebra fractures from 1988 to 2003. Evaluations included demographic features of patients, trauma mechanisms, fracture levels and types, treatment modalities, and associated injuries. The types of fractures were assessed according to the Denis classification. RESULTS: The types of fractures were classified as follows: compression fractures (n=212, 57.0%), burst fractures (n=146, 39.3%), seat belt-induced fractures (n=8, 2.2%), and fracture-dislocations (n=6, 1.6%). Involvement was at one level in 290 patients (77.9%), two levels in 61 patients (16.4%), three levels in 15 patients (4.0%), and four levels in six patients (1.6%). The most common localization was the thoracolumbar spine (transition zone) with 275 fractures (57.2%). The causes of fractures were fall from height in 211 patients (56.7%), traffic accidents in 145 patients (39.0%), and direct trauma in 16 patients (4.3%). Associated fractures were detected in 110 patients (29.6%), the most common being calcaneus fractures in 35 patients (9.4%). Apart from orthopedic problems, 38 patients (10.2%) had other organ injuries and/or head trauma. Treatment was conservative in 302 patients (81.2%) and surgical in 70 patients (18.8%). CONCLUSION: Every patient presenting after a high-energy trauma should be regarded as having a vertebra fracture until proven otherwise. When a vertebra fracture is detected, investigation should be extended for involvement at other levels and associated injuries.

Adolescent↗

PubMed1991

[Principles of surgical treatment of closed injuries of the urethra and their sequelae].

An experience with treatment of closed injuries of the urethra and their sequellae in 278 patients is presented. Most of the patients (206) had fractures of pelvic bones resulting from a mechanical trauma (fall from height, automobile accident, compression). Different operative interventions on the injured urethra are described depending on the volume of the injuries and time of operation. The authors note high possibilities to restore the urethra at different periods of trauma disease.

Cystostomy↗

PubMed2005

Cerebrospinal fluid (CSF) rhinorrhoea and/or otorrhoea in patients with head injury.

The essence of this study is to investigate the incidence, clinical profile and outcome of conservative treatment of cerebrospinal fluid rhinorrhoea and/or otorrhoea in head injured patients. Records of head injured patients between 1991 and 2000 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria were retrieved and reviewed for demographic data, cause of head injury, incidence of CSF rhinorrhoea and/or otorrhoea and outcome of conservative management. Of the 794 patients, 39 (4.9%): 28 (71.8%) males and 11 (28.2%) females presented with CSF rhinorrhoea and/or otorrhoea. Nineteen (48.7%) of them had rhinorrhoea, 13 (33.3%) otorrhea and 7 (18%) had both. They were aged 1 to 60 years with a mean age of 28. More than 40% of them were aged 10 years or less and about a quarter were in the fourth decade of life. The commonest cause of injury in these patients was road traffic accident, 27 (69.2%). About a quarter sustained their injuries as a result of fall from height. The mortality rate among patients with CSF rhinorrhoea and/or otorrhoea (33.3%) was higher than among the total population of the head injured (23%). All survivors had spontaneous cessation of CSF leakage within two weeks of head injury. In our centre, the incidence of CSF rhinorrhoea and/or otorrhoea following head injury is 4.9%. Though this complication of head injury was associated with increased mortality rate, it does not appear to be a prognostic factor in head injury (P>0.05).

Adolescent↗

PubMed2006

[Intra-articular calcaneal fractures].

PURPOSE OF THE STUDY: In this retrospective evaluation the authors present the group of patients with intraarticular calcaneal fractures that were treated from an extended lateral approach. MATERIAL: In the period from 2001 to 2003, 32 patients with intra-articular calcaneal fractures were treated by osteosynthesis, using a plate, from the extended lateral approach. All patients were men at an average age of 41.7 years (range, 20 to 63 years). The most frequent cause of injury was a fall from height. A combined injury was recorded in eight patients. The right calcaneus was broken in 11 and the left one in 21 patients. Patients with bilateral calcaneal fractures were not included in the evaluation. METHODS: Preoperative X-ray and CT examinations of the fractured calcaneus were carried out in all patients. The Sanders classification of calcaneal fractures was used for fracture evaluation. All patients were treated from the extended lateral approach by osteosynthesis with the use of a plate. Spongioplasty using an autologous graft from the iliac crest or an allogenous graft was carried out in 21 and 11 patients, respectively. The patients were operated on within an average of 7.3 days of admission (1 to 16 days), and were followed up for at least one year (average, 30 months) after surgery. Postoperative evaluation was based on radiographs and the results of the Kerr rating system obtained from questionnaires. RESULTS: The outcomes were excellent, 36 %; very good, 44 %; good, 17 %; and poor, 3 %. The Böhler angle postoperatively assessed on radiographs was on average + 28.5 degrees. All patients showed bone union, and no pseudoarthrosis was recorded. One patient had to be treated for a late purulent complication requiring metal removal. One patient underwent early wound revision due to postoperative hematoma. The metal was removed on average at 13 months postoperatively (range, 2.5 to 26 months). DISCUSSION: The treatment of intra-articular calcaneal fractures is determined by the type of injury, state of soft issues in the limb injured, patient's status and surgeon's experience. CONCLUSIONS: Our results as well as literature data show that exact reduction of the posterior subtalar joint with internal osteosynthesis can achieve good clinical outcomes in patients with intraarticular calcaneal fractures, particularly when the fractures are classified as Sanders II and III types.

Adult↗

PubMed2006

[Exploration of surgical approaches of complex tibial plateau fractures].

OBJECTIVE: To evaluate the surgical treatment and its results of complex tibial plateau fractures. METHODS: From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males (including 1 case of bilateral), and 8 females, with mean age of 40.6 years (21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzker classification, type V fracture was found in 14 extremities, type VI in 11 extremities. All cases were operated with two-incision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days. RESULTS: All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 6-9 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healed after change dressing. The function of the knee was evaluated according to Rasmussen's criteria, the results were excellent in 10 limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs. CONCLUSION: The two-incision approaches reduced the complication of soft-tissue injury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.

Adult↗

PubMed2006

[Completed suicide in outline--on basis of Cracow's Institute of Forensic Medicine data in 1991-2000 years].

The study presents the results of research into completed suicide. The authors have analyzed cases of completed suicide committed in Cracow and it's environs in the years 1991-2000. The aim of the research is to describe some features of this phenomenon with it's transformations in the last periods. The presented material bases on archival data of postmortem examinations made in Cracow's Institute of Forensic Medicine. Analyses' were executed in reference of victims' sex, age and place of residence, number and frequency of suicides in Cracow population, methods, predictors and possible motives. The authors also present a sketch of the bibliography regarding the topic, and the comparison between the results of the present study and the results of earlier studies from Cracow environs of the phenomenon of suicide. 1933 cases of completed suicides were analysed, from what over a half concerned occupants of our city. The average coefficient for 100 000 occupants carried out 13.2. There were 1485 men and 448 women among victims, in age from 13 to 95 years. Male to female avarage ratio carried out 3.3:1 in the described period.. Average age carried out 45.5 years, for men 44.5, and for women 48.8 years. The superiority of men is strongly visible in groups of young persons and in "middle age". Results from archival data show that, hanging was the the most frequent way of suicide. In studied material there were more then 63% cases of suicidal hanging. Falls from height, poisonings and drownings were next in line. In very considerable number of cases (almost 60%) the presence of mental disorder in anamnesis was affirmed. This concerned particularly women where the most frequent were depression disorders. For men, first of all factors was dependence from acohol. Over one third of the victims were pensioners and unemployeds. The level of ethanol in blood in 718 cases was crossed 0.5 promille.

Adolescent↗

PubMed2006

[Evaluation of pediatric patients with traumatic hip dislocation].

OBJECTIVES: We evaluated pediatric patients who were treated for traumatic dislocation of the hip. METHODS: Traumatic dislocation of the hip was detected in five children (all boys; mean age 9 years; range 7 to 13 years) between 1991 and 2005. Dislocations occurred in the right hip in four cases, and in the left hip in one, all of which had posterior localization. Etiology was fall during play in two children, and fall from height or car crash in three. One patient had posterior wall avulsion fracture of the acetabulum. Early radiologic follow-ups included conventional radiographs and computed tomography. Functional results were assessed with the Harris hip scoring system. Four patients had a sufficient follow-up period with a mean of 44 months (range 19 to 64 months). RESULTS: All the patients were treated with closed reduction under general anesthesia after a mean of 6.4 hours (range 2 to 16 hours) following trauma. Functional results were excellent in all the patients, with a mean Harris hip score of 92 (range 84 to 96). Based on early postoperative radiologic control with computed tomography, no surgical intervention was considered for posterior wall avulsion fracture of the acetabulum in one patient. At 40-month follow-up, he had no complaints, had a full range of motion and a hip score of 92. While no complications were observed in patients undergoing early reduction, one patient whose dislocation was reduced 16 hours after trauma developed avascular necrosis of the femur head 18 months after treatment, at which time his hip score was 84. CONCLUSION: Early reduction is of particular importance for the follow-up course of traumatic hip dislocations in childhood.

Adolescent↗

PubMed1991

Survival in trauma victims with pulmonary contusion.

The author evaluated 203 consecutive patients with severe chest trauma admitted to the trauma center between 1985 and 1989. The goal was to identify risk factors that play a significant role in mortality of patients with pulmonary contusion. There were 160 men and 43 women. The average was 33 years (range 2 to 92 years); 178 patients were younger than 60 years and 25 were older. There were 183 motor vehicle or motorcycle accidents, five gun shot wounds, one stab wound, five falls from height, three industrial accidents, one altercation, and five other undetermined causes. One hundred and fifty-nine patients survived; 44 died (22%). Their injury severity scores averaged 27 (range 9 to 59) for the survivors and 43.5 (range 17 to 75) for the nonsurvivors. Fifty-seven per cent of the patients required mechanical ventilation. The average time on the ventilator was 4.4 days (range 1 to 47 days) for the survivors and 14.2 days for the nonsurvivors (range 1 to 126 days). Of the patients less than 60 years old, 34 (20%) died, but 10 (40%) of the 25 patients older than 60 years died. Average blood loss was 1,047 cc (range 0 to 14,300 cc), but the difference was not statistically significant between survivors and nonsurvivors in the authors' series. Injuries to the central nervous system were present in 80 (40%) of the patients and were associated with death in 30 (68%) of the cases. Age, severity of injury, associated head trauma, and shock were the most important factors affecting survival in the authors' patients with pulmonary contusion.

Adolescent↗

PubMed1991

Lisfranc fracture-dislocations: report of two cases.

Lisfranc fracture-dislocation is a rare but sometimes dramatic injury, most commonly associated with motor vehicle and industrial accidents, and falls from heights. Radiographic examination is a crucial point in the work-up of these patients. The most common findings on plain radiographs are separation of the bases of the first and second metatarsals and the "fleck" sign, a bony fragment resulting from a fracture of the base of the first or second metatarsal. These fractures are demonstrated in the two cases presented. We conclude that these lesions can usually be diagnosed with plain radiographs if scrupulous attention is paid when evaluating the normal anatomic alignments. Computed tomography should be reserved for equivocal cases.

Adult↗

PubMed1990

Trauma to the foot.

Minor trauma to the foot may cause stress fracture, avulsion fracture or ligamentous and tendon injury. Plain radiographs are frequently normal. Radionuclide bone scan is a sensitive detector of early bone injury. A stress fracture may develop focal uptake or diffuse uptake throughout the bone involved. MR imaging is the most sensitive means of evaluating injury to the soft tissues. Acute edema, partial tear, complete tear, and chronic tendinitis have distinct features on T1- and T2-weighted images. Major trauma occurs most commonly as a result of falls from heights and from motor-vehicle accidents. Plain films are useful in the initial evaluation of the extent of trauma. CT is particularly useful in evaluating calcaneal fractures that involve the subtalar joint. Both MR imaging and CT scans are useful in detecting injured or entrapped tendons associated with fracture-dislocations.

Foot Injuries↗

PubMed1989

[Injuries of the diaphragm].

Diaphragmal injuries are rare but serious. They are caused by traffic accidents, murder or suicide, fall from height, crush or blast injuries. Mechanisms of diaphragmal rupture may be various: sudden intraabdominal pressure increase, transferred strike force from pelvis (like "contra coup"), direct pressure on one or both hemitoracices, injuries piercing or sclopetar. Negative intraabdominal pressure is convenient for prolapse of abdominal organs into pleural cavity. Ruptures were more often of tendinous than muscular part of diaphragm, and they were more often on left side. Diaphragmal injuries can be: open--percutaneous (thoracoabdominal) and closed--subcutaneous. There are three types of thoracoabdominal injuries: thoracoabdominal, abdominothoracal and thoraco-retroperitoneal. Open diaphragm injuries are followed by shock, hemorrhages, cardiopulmonary disfunction, haematothoracic, peritonitis and other lesions. Closed diaphragmal injuries can be manifested clinically or latent. In the first stage of treatment there is a conservative approach (solving the shock) and in the second stage surgical approach. More often thoracotomy is better than laparotomy and the place of incision depends on localisation of injuries and clinical signs. During last 10 years we surgically treated 19 diaphragmal injuries with mortality rate of 15.9% (3). Most frequent causes of injuries were traffic accidents or sclopetar injury, and the predominant compression. Diaphragmal lesions were a part of thoracoabdominal injuries and politraumas with high mortality rate. The frequency of injuries of other abdominal organs was the following: spleen, lungs, liver, stomach, bowel, kidney, bladder, retroperitoneal blood vessels, legs, arms and pelvis. The treatment of diaphragmal injuries requires multidisciplinary, experienced surgery team with well equipped anaesthesiology and reanimation unit.

Adult↗

PubMed1989

Suicide mortality in the Maryland state prison system, 1979 through 1987.

Prisoners are reported to have a higher suicide rate than the community. We studied suicides in the Maryland prison system to determine the level of risk and risk factors for inmate suicide. There were 37 male inmate suicide deaths between 1979 and 1987 (39.6 suicides per 100,000 male inmates), which is significantly higher than the age- and race-adjusted male suicide rate in the general population of Maryland (22.0 per 100,000). Risk of male inmate suicide was increased for the following characteristics: white race (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1 to 3.9), age 25 to 34 years (RR, 1.8; 95% CI, 1.0 to 3.4), major crime committed against person (RR, 3.4; 95% CI, 1.7 to 6.7), life sentence (RR, 4.7; 95% CI, 2.2 to 10.0), and classification to the major maximum security institution in the prison system (RR, 5.1; 95% CI, 2.7 to 9.8). The methods of suicide chosen by inmates were hanging (86%), cutting wound (5%), antidepressant overdose (5%), and fall from height (3%). We conclude that inmate suicide represents a significant correctional health and public health problem. Specific implications for prevention of inmate suicide are examined.

Black or African American↗

PubMed1989

The role of preparation in tuning anticipatory and reflex responses during catching.

The pattern of muscle responses associated with catching a ball in the presence of vision was investigated by independently varying the height of the drop and the mass of the ball. It was found that the anticipatory EMG responses comprised early and late components. The early components were produced at a roughly constant latency (about 130 msec) from the time of ball release. Their mean amplitude decreased with increasing height of fall. Late components represented the major build-up of muscle activity preceding the ball's impact and were accompanied by limb flexion. Their onset time was roughly constant (about 100 msec) with respect to the time of impact (except in wrist extensors). This indicates that the timing of these responses was based on an accurate estimate of the instantaneous values of the time-to-contact (time remaining before impact). The mean amplitude of the late anticipatory responses increased linearly with the expected momentum of the ball at impact. The reflex responses evoked by the ball's impact consisted in a short-latency coactivation of flexor and extensor muscles at the elbow and wrist joints. Their mean amplitude generally increased with the intensity of the perturbation both in the stretched muscles and in the shortening muscles. We argue that both the anticipatory and the reflex coactivation are centrally preset in preparation for catching and are instrumental for stabilizing limb posture after impact. A model with linear, time-varying viscoelastic coefficients was used to assess the neural and mechanical contributions to the damping of limb oscillations induced by the ball's impact. The model demonstrates that (1) anticipatory muscle stiffening and anticipatory flexion of the limb are synergistic in building up resistance of the hand to vertical displacement and (2) the reflex coactivation produces a further increment of hand stiffness and viscosity which tends to offset the decrement which would result from the limb extension produced by the impact.

Adult↗

PubMed1989

Adaptation to suppression of visual information during catching.

We address the problem of whether and how adaptation to suppression of visual information occurs in catching behavior. To this end, subjects were provided with advance information about the height of fall and the mass of a ball and an auditory cue signaled the time of release. Adaptation did occur, as indicated by the unimpaired ability to catch the ball without vision; however, it involved a major reorganization of the muscle responses. The subjects were unable to produce anticipatory activity consistently, but preset the responses elicited by the impact. These responses were more complex and prolonged than those observed in the control experiments (with vision). In particular, medium- and long-latency responses were much larger, and the changes in elbow, wrist, and metacarpophalangeal angles following impact were more oscillatory than in the control. The general pattern of the EMG responses switched from that characteristic of catching with vision to that characteristic of catching without vision from the first trial of each experiment. However, the responses produced without vision were calibrated adaptively in the course of an experiment. In fact, the limb oscillations induced by the impact were significantly larger in the first trial than in the following trials. This seems to suggest that the parameters of the responses are adjusted based on an internal model of the dynamic interaction between the falling ball and the limb. This model is initially constructed from a priori knowledge on impact parameters and is subsequently updated on the basis of the kinesthetic and cutaneous information obtained during the first trial.

Adaptation, Psychological↗