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PubMed1988

[Epidural hematoma without intradural lesions--clinical study of 120 cases].

One hundred twenty cases of epidural hematoma without intradural lesion treated between 1975 and 1983 to which CT scan was available, were presented. Mortality rate was 1.7% and morbidity rate was 6.7%. In all cases of epidural hematoma including with and without intradural lesion in the same term (164 cases), mortality and morbidity rate were 7.3 and 10.4% respectively. Ninety five cases were male and 25 cases were female. Causes of injury were falls from a height (42 cases, 35%), traffic accident (41 cases, 34%), and falls at ground level (24 cases, 20%). The site of hematoma in 120 cases of 128 hematoma were frontal (17 cases, 13%), temporoparietal (74 cases, 58%), parasagittal (4 cases, 3%), middle fossa (8 cases, 6%), occipital (16 cases, 13%) and posterior fossa (9 cases, 7%). Fractures were shown in 109 cases out of 120 cases on skull X-P and depressed fractures were 12 cases. Those which showed no fracture on skull X-P, revealed slow growth of hematoma and delayed onset of clinical signs and were mainly children. Seven operated cases of epidural hematoma does not show fractures on skull X-P nor initial unconscious. Clinical course of disturbance of consciousness were divided in five types as follows; I. no unconsciousness (22 cases, 18%), II. latent interval (17 cases, 14%), III. primary but no secondary unconsciousness (29 cases, 24%), IV. lucid interval (22 cases, 18%), V. unconscious throughout (16 cases, 14%) and unknown (14 cases, 12%). Cases which Glasgow Coma Scale Score were over 7 showed good recovery in Glasgow Outcome Scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

Prediction of femoral impact forces in falls on the hip.

A major determinant of the risk of hip fracture in a fall from standing height is the force applied to the femur at impact. This force is determined by the impact velocity of the hip and the effective mass, stiffness, and damping of the body at the moment of contact. We have developed a simple experiment (the pelvis release experiment) to measure the effective stiffness and damping of the body when a step change in force is applied to the lateral aspect of the hip. Results from pelvis release experiments with 14 human subjects suggest that both increased soft tissue thickness over the hip and impacting the ground in a relaxed state can decrease the effective stiffness of the body, and subsequently reduce peak impact forces. Comparison between our fall impact force predictions and in-vitro measures of femoral fracture strength suggest that any fall from standing height producing direct, lateral impact on the greater trochanter can fracture the elderly hip.

Accidental Falls↗

PubMed2006

External fixation of open subtalar dislocation.

Subtalar dislocation is a rare and severe injury, caused by high-energy trauma such as fall from a height or traffic accident. Infection and avascular necrosis are not rare sequelae of open subtalar dislocation, and the outcome may be poor. External fixation allows complete wound care, and moderate distraction of the ankle joint should unload the talus, which may reduce the risk of avascular necrosis. We treated 11 open subtalar dislocations by distractional external fixation. The series involved nine males and two females, of average age 30.39 years. In nine cases the injury was caused by falling from a height, and in two by a traffic accident. The follow-up period ranged from 18 to 28 months. The final functional results were good, with no infection and one case of avascular necrosis of the talus. Pain after a longer period of walking or standing was experienced by eight patients, and movement of the subtalar joint was limited in nine patients. Immediate distractional external fixation of open subtalar dislocation may prevent infection and avascular necrosis of the talus.

Adult↗

PubMed2003

Suicide trends in Singapore: two decades down the road.

In this study, recent trends in the incidence and methods of suicide in Singapore, over the period 1991-2000, were compared with the results of a previous study covering the period 1975-1984 (Tan, 1986). The present study included a total of 3,834 suicidal deaths reported to the coroner and investigated by the Centre for Forensic Medicine of the Health Sciences Authority. The results showed that the crude suicide rate had stabilised over the last decade and that the rate was highest among elderly males. The three most common methods employed were falls from a height (69.3%), hanging (20.7%) and poisoning (5.5%). Comparison of the results of both studies showed that the crude suicide rate had stabilised over the last two decades. However, there was an increase in the suicide rates among males, as compared with the previous study, and a marginal decrease in suicide rates among females over this time. There was also an appreciable change in the methods of suicide employed, in that there was an increase in the proportion of deaths due to falls from a height and corresponding reductions in the proportions of deaths by hanging and poisoning.

Adolescent↗

PubMed2006

Single question about drunkenness to detect college students at risk for injury.

OBJECTIVES: To examine the frequency of injuries reported by college students who replied affirmatively to the question, "In a typical week, how many days do you get drunk?" METHODS: In Fall 2003, a Web-based survey was administered to a stratified random sample of 3,909 college students from ten North Carolina (NC) universities. Students answered questions regarding alcohol use and its consequences. Data were analyzed using multiple logistic regression, controlling for within-school clustering of drinking behaviors and adjusting for other significant covariates. Adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated for significant predictors (p < 0.05). RESULTS: Two thousand four hundred eighty-eight students reported that they are current drinkers; 1,353 (54.4%) reported getting drunk at least once in a typical week. Compared with students who did not report getting drunk at least once a week, these students had higher odds of being hurt or injured at least once as a result of their own drinking (AOR = 4.97; 95% CI = 3.47 to 7.09), experiencing a fall from a height that required medical treatment (AOR = 2.16; 95% CI = 1.36 to 3.43), and being taken advantage of sexually as a result of another's drinking (AOR = 2.59; 95% CI = 1.72 to 3.89). Students who reported getting drunk at least one day in a typical week also were more likely to cause an injury requiring medical treatment to someone else. They had higher odds of causing injury in an automobile crash (AOR = 1.84; 95% CI = 1.01 to 3.40), of causing a burn that required medical treatment (AOR = 2.85; 95% CI = 1.51 to 5.39), and of causing a fall from a height that required medical treatment (AOR = 2.02; 95% CI = 1.01 to 4.04). Getting drunk was a better indicator of "self-experienced injury" and of "injury caused to someone else" than was binge drinking, for all outcomes (p < 0.05). CONCLUSIONS: The single question, "In a typical week, how many days do you get drunk?" identifies college students who are at higher than normal risk of injury as a result of their own drinking and the drinking of others. Future research should assess this question's effectiveness as a screening tool in campus health centers and in emergency departments.

Accidental Falls↗

PubMed1991

Fracture prediction for the proximal femur using finite element models: Part I--Linear analysis.

Over 90 percent of the more than 250,000 hip fractures that occur annually in the United States are the result of falls from standing height. Despite this, the stresses associated with femoral fracture from a fall have not been investigated previously. Our objectives were to use three-dimensional finite element models of the proximal femur (with geometries and material properties based directly on quantitative computed tomography) to compare predicted stress distributions for one-legged stance and for a fall to the lateral greater trochanter. We also wished to test the correspondence between model predictions and in vitro strain gage data and failure loads for cadaveric femora subjected to these loading conditions. An additional goal was to use the model predictions to compare the sensitivity of several imaging sites in the proximal femur which are used for the in vivo prediction of hip fracture risk. In this first of two parts, linear finite element models of two unpaired human cadaveric femora were generated. In Part II, the models were extended to include nonlinear material properties for the cortical and trabecular bone. While there was poor correspondence between strain gage data and model predictions, there was excellent agreement between the in vitro failure data and the linear model, especially using a von Mises effective strain failure criterion. Both the onset of structural yielding (within 22 and 4 percent) and the load at fracture (within 8 and 5 percent) were predicted accurately for the two femora tested. For the simulation of one-legged stance, the peak stresses occurred in the primary compressive trabeculae of the subcapital region.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗

PubMed1984

Chest injuries in children.

Chest injuries of varying severity occur commonly in children, much more as a result of motor vehicle accidents and falls from a height than from penetration. The author reviews the injuries that occur with reference to mechanism, immediate and late treatment and monitoring. The differences between the injuries of children and those of adults stem from the greater resilience of most structures in children; bony injuries are not necessarily extensive even when disruptions of the lung and blood vessels are serious. Pneumothorax may occur alone or with other injuries. A chest tube should be inserted early. Persistence of the pneumothorax may indicate the presence of a tracheobronchial tear which must be repaired by thoracotomy. A flail chest may be treated without intubation if blood-gas levels are normal. In the presence of paradoxical motion and increased carbon dioxide pressure, intubation and positive-pressure ventilation are required for a few days. Penetrating wounds require the same care as in adults. Diaphragmatic tears occur from falls from excessive heights or direct passage of vehicle wheels over the chest or abdomen. Ventilation becomes progressively more inefficient. Esophageal tears occur from irregular foreign bodies. Great-vessel injuries occur by penetration. The author establishes priorities in management to assure adequate oxygen utilization, arrest of hemorrhage and restoration of circulation. Following stabilization efforts, monitoring procedures are instituted. These include insertion of central venous pressure and arterial lines to measure pH, carbon dioxide and cardiac output as well as for other biochemical and hematologic measurements.

Bronchi↗

PubMed2006

Calcaneal bone mineral density in older patients who have fallen.

BACKGROUND: Annually, 35-40% of those aged >65 years fall; up to 5% of such falls result in fracture. Fracture is determined both by propensity to fall and by bone fragility. AIM: To determine osteoporosis prevalence and predictors in patients who have fallen. DESIGN: Observational cross-sectional study. METHODS: We measured calcaneal BMD in 408 consecutive patients aged >50 years attending after falling. Fall number, fracture history, weight, height, and risk factors for falls and osteoporosis were recorded. T scores (SD above or below the mean for young adults) were derived in both sexes, and Z scores (SD above or below age-related normal score) in females. RESULTS: In females (n = 300, 74%), mean (SD) T score was -1.1(1.6), and mean Z score was 0(1.4); 127 (42%) had osteoporosis (T score < - 1.6). ROC curves confirmed significant relationships between osteoporosis and age, weight and height (all p < 0.0001). Incorporating fracture history, our model (fracture aged >50 years, age >83 years, weight <57 kg, height <153 cm as dichotomous variables) predicted osteoporosis with 91% sensitivity, 34% specificity. Of 108 male fallers, 36 (33%) had osteoporosis. Age, height and weight all predicted osteoporosis (p < 0.02). The resulting model (fracture aged >50 years, age > or =80 years, weight < or =68 kg, height < or =167 cm as dichotomous variables) predicted osteoporosis with 92% sensitivity, 30% specificity. DISCUSSION: Osteoporosis prevalence is not increased in female fallers compared to age-related norms; empirical use of osteoporosis treatment solely on the basis of falls thus appears inappropriate. In both sexes, the factors predicting osteoporosis were age, height and weight. Where BMD is not practical, possible or economical, our model may be a sensitive means of predicting fallers with osteoporosis.

Absorptiometry, Photon↗

PubMed1988

Why do children break their arms?

Over a 1-year period the mode of fracture of the long bones of children's upper limbs was analysed. There were 277 fractures and 4 dislocations recorded. The most common fractures were of the distal radius and ulna. Most injuries were due to falls from a low height but those from a high fall necessitated hospital admission most frequently. Preventative measures are discussed.

Accidental Falls↗

PubMed2003

Test method for retractable type fall arresters designed for horizontal use.

Retractable type fall arresters are designed to protect against falls from a height of people who need freedom of vertical movement. The practice of fall protection shows that the devices are also used to protect people who work on flat roofs. This application creates quite different operating conditions for the devices. In some situations those conditions can be dangerous for users. The article presents a theoretical analysis of phenomena occurring during a fall arrest with retractable type fall arresters arranged horizontally. The analysis was verified with laboratory tests. The article presents a proposal for the construction of a test stand and a test method for estimating retractable type fall arresters intended for horizontal use.

Accidental Falls↗

PubMed2004

Spinal cord injuries due to falls from hunting tree stands in Oklahoma, 1988-1999.

Serious injuries resulting in paralysis or death have been shown to occur to hunters who have sustained falls from tree stands. A total of sixteen spinal cord injuries or deaths among Oklahoma hunters falling from tree stands were reported between 1987 and 1999. The mean height of the falls was 16.4 feet. Three (18.8%) of the cases were related to substance use. None of the patients were using a safety restraint. Nearly 90% of the injuries resulted in paraplegia/paresis; two (12.5%) of the injuries resulted in death. Forty-four percent of the spinal injuries occurred at the thoraco-lumbor junction (T12 or L1). Burst fractures were the most common fracture pattern. Hospitalizations averaged 19.6 days (range 3 to 73 days) and eight (50%) were discharged to inpatient rehabilitation facilities. Falls from tree stands can result in serious injuries or death. Hunter education and the use of safety harnesses for prevention of injuries related to tree stands are paramount.

Accidental Falls↗

PubMed2004

[Injuries to the lower cervical spine].

PURPOSE OF THE STUDY: The authors present a retrospective evaluation of a group of patients with injury to the lower cervical spine. The aim of the study is to show current trends in the diagnosis and treatment of this trauma. MATERIAL: Between 1995 and 2003, 363 patients with trauma to the lower cervical spine were treated in our clinic. They included 63 women and 300 men, who fell into age categories as follows:14-19 years, 52 patients; 20-29, 108 patients; 30-39, 76 patients; 40-49, 57 patients; 50-59, 40 patients; 60-69, 22 patients; over 70, 8 patients. Neurological findings were classified as Frankel A in 109 patients, Frankel B in 24 patients, Frankel C in 19 patients, Frankel D in 12 patients and Frankel E in 199 patients. The trauma was due to a car or motorcycle accident in 183 patients, a fall from a height in 67 patients, a dive in water in 57 patients, a fall of the pedestrian in 47 patients and other causes in 9 patients. According to the level of the vertebra injured, fractures of the fifth cervical vertebra and the C6/7 segment were most frequent; fractures of the C7/T1 segment were least frequent. The AO classification showed type A injury in 22 %, type B in 23 % and type C in 55 % of the patients. METHODS: Conservative treatment was carried out in 100 patients, of whom 56 had a halo vest and 44 received a Philadelphia collar. Surgery was performed in 463 patients, most of whom, i. e., 246 patients, were treated from the anterior approach. Monocortical stabilization was used in 228 patients, bicortical fixation in 18 patients. Fifteen patients were treated from the posterior approach and two patients underwent a combined two-stage treatment. RESULTS: In the group of 263 patients treated surgically, there were several complications. Injury to the recurrent laryngeal nerve were recorded in nine patients, an abscess in the operative wound following the anterior approach developed in one patient and a hematoma of the anterior operation wound requiring revision surgery occurred in two patients. Complications involving implants were the following: fracture of the anterior plate in one patient, failure of anterior plate fusion in two patients, failure of posterior plate fusion in one patient and loosening of two anterior, bicortically inserted screws in one patient. Pseudoarthrosis was recorded in one patient with a fracture of the cervical spine locking plate. In the remaining patients (99.8 %) bony union was achieved by 6 months. Of the 363 patients, 164 had a medullary lesion; of these 17 died. Sixteen were classified as having Frankel A lesions and one having a Frankel B lesion. The cause of death was unrelated to the operation. Six patients with neurological deficit were transferred abroad. A patient diagnosed by the neurologist as Frankel A remained included in this group, although an improvement in his neurological status suggested an incomplete medullary lesion. Of the 141 patients with neurological deficit who were followed up for more than one year, 60 showed an improvement in neurological findings. DISCUSSION: The treatment of fractures of the lower cervical spine aims a decompression of the affected nerve structures and at restoration of the correct position and stability of the cervical spine. It is predominantly performed from the anterior approach; the posterior approach is used less frequently, only when indicated. CONCLUSIONS: The diagnosis of injuries to the lower cervical spine is based on the medical history, X-ray images in three basic projections and a CT scan. The necessity of a pre-operative MRI examination has recently been discussed. The use of the anterior approach in treatment of the injured lower spine is safe and effective. It allows us to carry out decompression as well as insertion of a graft and plate under direct visual control. It is associated with a minimum of complications and a high probability of bony fusion. Only immediate decompression will facilitate the regeneration of an injured spinal cord. Key words: cervical spine, spinal injury, anterior fixation.

Adult↗

PubMed2001

Ladders: accidents waiting to happen.

OBJECTIVES: To examine the nature, severity and outcomes of injuries sustained from ladder falls. DESIGN: Retrospective survey of medical records. PATIENTS AND SETTING: Patients who presented after a fall from a ladder to the emergency department of a tertiary hospital in Melbourne, Victoria, between January 1994 and December 1997. MAIN OUTCOME MEASURES: Demographic characteristics; height and mechanism of fall; injury site and Injury Severity Score (ISS); rate of hospital admissions. RESULTS: 163 patients presented after ladder falls. They were aged 2.5 to 86 years (mean age, 48 years); 83% were male, and 78% were injured in non-occupational settings. Almost half the accidents (43%) were caused by ladder instability (ladder sliding from position or tilting sideways). Most patients had mild or moderate injuries (usually of the extremities), but 13% had an ISS > or = 16 (indicating severe trauma), usually with head, chest or spinal injuries; 42% were admitted to hospital. Multiple regression analyses showed that ISS increased signficantly with height of fall and age (P< 0.05 for both), although a substantial amount of variation was not attributable to these variables. Likelihood of hospital admission increased linearly with increasing ISS to an ISS of 8 and remained high thereafter. CONCLUSIONS: Ladder falls resulted in significant morbidity, with men undertaking non-occupational activities comprising most of those injured. New strategies to encourage safe ladder use are needed.

Accidental Falls↗

PubMed1991

Vertical deceleration trauma. Principles of management.

A highly complex interaction of several physical and biomechanical factors determines the patterns of injury and probability of survival in free falls. Falls from extreme heights result in massive visceral and vascular injuries, which are usually lethal. Urban falls tend to result in severe lower extremity, spinal, and pelvic fractures. Retroperitoneal hemorrhage is a significant cause of death and is best managed by emergency angiography and embolization. Early fixation of fractures reduces morbidity.

Accidental Falls↗

PubMed1997

A concussive-like brain injury model in mice (I): impairment in learning and memory.

The modeling of human concussive brain injury (CBI) in the laboratory has been challenging. In the present study, we developed an experimental CBI model in mice using a novel weight-drop device. Various injury levels were examined by adjusting the height of the falling weight (diameter 10 mm, length 20 cm, weight 21 g). At a height of 50 cm, the impact resulted in a mortality rate of 46.7% with a skull fracture rate of 28.6%. At a height of 25 cm, however, the impact produced a concussive-like brain injury (CLBI) to the mice without skull fracture. A series of pathophysiological and neurobehavioral responses was evaluated at this injury level. The CLBI mice lost muscle tone and righting reflex response immediately following the trauma and recovered from the latter within a short duration of 1.6 +/- 0.32 min (mean +/- SE). Brain edema formation started at 12 h, reached a maximum at 24 h and recovered 48 h. Typically edema was found in the neocortex, hippocampus, and cerebellum, but not in the brain stem. Deficits in the feeding behaviors lasted for 2 days, accompanied by lower body weight persisting for 5 days. The body weight growth rate for 24 h returned to the control levels by the third day postinjury. Learning and memory were evaluated at the end of 1-3 weeks after the trauma using a water-finding task. At 1 week, exploratory behaviors were slightly inhibited while learning and memory were profoundly impaired. Interestingly, the learning and memory deficits lasted for 2 weeks while recovering to the control levels by 3 weeks. No motor disability was found in the CLBI mice during the 3-week evaluations. These results indicate that the weight-drop impact produced graded injury to the brain, and at the injury level of 25 cm it produced a CLBI in the mice in which the characteristics of transient loss of neurobehavioral responses, short duration of brain edema, and long-lasting learning and memory deficits are similar to those of human CBI.

Animals↗

PubMedDate not supplied

Etiology of supracondylar humerus fractures.

The specific etiology of supracondylar humerus fractures in children is not well known. All supracondylar humerus fractures treated at Children's Hospital and Health Center, San Diego (CHSD) over an 8-year period (n = 391) were reviewed to determine specific information about the manner in which the injury occurred. Girls tended to sustain these fractures more often, and the nondominant arm was more often injured. Falls from a height accounted for 70% of the fractures. Children < or = 3 years old tended to fall off of household objects (beds, couches, other objects 3-6 feet high), and children 4 years and older tended to fall from playground equipment such as monkey bars, slides, and swings. Safety precautions should be implemented in homes of young children and at playgrounds to avoid these fractures.

Accidental Falls↗

PubMed1996

Vertical deceleration injuries: a comparative study of the injury patterns of 101 patients after accidental and intentional high falls.

We analysed the pattern of injury of 101 adult patients who were treated in our Trauma Center after a fall from an average height of 7.2 m between 1987 and 1990. In 62 patients the fall was accidental, and 39 jumped with suicidal intent. The most common injuries were fractures of the thoracic and lumbar spine (83.0 per cent) especially of the thoracolumbar junction. The pattern of limb injuries is towards a significant preference of the metaphyseal and epiphyseal parts of the bones of the distal joints (wrist, elbow, ankle, subtalar). Fractures of the diaphyseal areas and the proximal joints (shoulder, humerus, hip, femur) were rare. The incidence of thoracic (20.8 per cent) and pelvic injuries (30.0 per cent) was relatively lower. Blunt abdominal injury (5.9 per cent) was rare after a fall from a great height. Head injuries occurred in only 27 per cent of our patients who all survived their transport to hospital. There is no significant difference in injury patterns between deliberate and accidental falls, but there is a higher number of isolated injuries in all patients after unsuccessful suicidal jumps.

Accidental Falls↗

PubMed2001

Empirical estimators of gamma fits to tracer-dilution curves and their technical basis and practical scope.

A gamma fit facilitates smoothing and extrapolation of distorted tracer-dilution curves in blood flow studies. Theoretically based empirical estimators were developed as simple alternatives to direct regression approaches from simulated gamma distributions with a wide range of shape asymmetry. Key curve features of peak height p, full width w at half peak height, rising and falling limb inflection tangents and asymmetry of the peak time with respect to the p/2 height occurrences were related to the parameters of the distribution by multiple linear regression after suitable transformations. The product pw was simply related to the total area A under the curve, pw/A being 0.93 +/- 0.01 in 70 cardiac output determinations from ten surgical patients. Shape and scale parameters were closely related to the standard deviation, inflection point properties and w for the curves. Mensuration devices suitable for cardiac output computers were developed that calculated total areas from incomplete portions under gamma curves and by-passed the need for parameter estimation. There was limited point in estimating the distribution parameters just to derive particle transit times, because of the ad hoc nature of the fitting form, which did not allow for the back-dispersion by Brownian motion of tracer molecules diluting in blood flow. Nonetheless, the accuracy of area prediction using a gamma fit was adequate for most clinical purposes and comparable to that via the random walk function, giving good insight to established results and computing procedures.

Algorithms↗