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PubMed1993

Impact near the hip dominates fracture risk in elderly nursing home residents who fall.

Hip fractures among the elderly are a significant and rapidly growing public health problem. The prevailing view is that most hip fractures are the consequence of age-related bone loss or osteoporosis. However, because over 90% of hip fractures are the result of falls, we have undertaken a falls surveillance study to determine if factors related to the mechanics of falling are associated with increased risk of hip fracture. Case subjects with hip fracture and control subjects without hip fracture were sampled from falls recorded at the Hebrew Rehabilitation Center for Aged, a chronic care facility. Fall information was obtained by interview of the subject and witnesses if the fall was witnessed. Data were analyzed by multiple logistic regression. Increased risk of hip fracture from a fall was associated with impacting on the hip or side of the leg and potential energy associated with the fall. Quetelet, or body mass index, was inversely related to fracture risk. The adjusted odds ratio of hip fracture for a fall involving impact on the hip region was 21.7 (95% confidence interval, 8.2-58). The potential energy associated with these falls was an order of magnitude greater than the average energy required to fracture elderly, cadaveric, proximal femurs in earlier in vitro experiments. We conclude, therefore, that a fall from standing height should no longer be considered minimal trauma but rather trauma of sufficient magnitude to pose a high risk of hip fracture if impact occurs on the hip and if energy-absorbing processes are inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗

PubMed1996

[Strategy of the surgeon in rectal injuries].

Mechanical rectal injuries are severe traumas of the gastrointestinal tract which often cause fatal complications. The etiology of injuries to the rectum is diverse. They are inflicted with knives, occur in blunt injury of the abdomen, in injury with foreign objects, in falling from a height on a sharp object. Particularly important are traumas occurring during medical manipulations: in giving an enema, during rectosigmoidoscopy and colonoscopy, in electrocoagulation of polyps. Various methods are applied for the treatment of rectal injuries in intra- and extraperitoneal traumas, and an individual approach is needed in each case.

Abdominal Injuries↗

PubMed1980

Further studies on the actions of salicylates on nerve membranes.

The effects of sodium salicylate, sodium benzoate and 5-bromo salicylate on nerve fibres of the rabbit cervical vagus and of the frog sciatic nerve 'in vitro' were studied and using the single sucrose gap technique. The application of 5-bromo salicylate in concentrations between 2 X 10(-3) to 5 X 10(-3) M induced a slow fall in spike height accompanied by a small hyperpolarization (0.5--2.0 mV). Higher concentrations (1 X 10(-2)--2 X 10(-2) M) produced depolarization and a rapid block of nervous conduction. Concentrations of 1 X 10(-2)--2 X 10(-2) M of sodium salicylate were needed to induce the same hyperpolarizing and slow blocking effects in non-myelinated nerve fibres. Myelinated fibres of the frog sciatic nerve were also blocked by concentrations greater than 1 X 10(-2) M of 5-bromo salicylate, but showed an increase in the amplitude of the compound action potential and a prolonged falling phase when superfused with concentrations around 5 X 10(-3) M. A frequency-dependent decrease in the action potential amplitude was observed with sodium salicylate and 5-bromo salicylate and was shown to be more easily induced in non-myelinated than in myelinated fibres. 5-Bromo salicylate (2 X 10(-2) M) and 2,4-dinitrophenol (1 X 10(-4) M) reduced the amplitude and the rate constant of decay of the hyperpolarization produced by tetanic stimulation of non-myelinated nerve fibres. Sodium salicylate (2 X 10(-2) M) increased the time constant of decay of the hyperpolarization of the potassium-activated response and slightly decreased its amplitude. Sodium salicylate was 3--5 times less potent than 5-bromo salicylate; while sodium benzoate was practically ineffective in producing the phenomena under study.

Action Potentials↗

PubMed1990

The pubertal growth spurt in eight patients with true precocious puberty and growth hormone deficiency: evidence for a direct role of sex steroids.

The relative contributions of GH, insulin-like growth factor-I (IGF-I), estradiol, and testosterone to the pubertal growth spurt are incompletely understood. We studied 8 patients (5 girls and 3 boys) with true precocious puberty and GH deficiency due to CNS lesions to assess the role of sex steroids in pubertal growth independent of an increase in circulating GH. Included is 1 patient with an unusual hypothalamic lesion due to head trauma. A control group of 17 GH-sufficient patients with true precocious puberty (13 girls and 4 boys) was matched for chronological age. The GH-deficient girls grew at a mean velocity of 9.2 cm/yr (range, 7.2-14.4), and the boy's mean height velocity was 7.9 cm/yr (6.1-9.9). Mean bone age was advanced in the GH-deficient group (girls, +2.7 SD; boys, +2.6 SD), but not as much as the GH-sufficient controls (girls, +5.4 SD; boys, +4.3 SD). The mean concentration of plasma IGF-I was lower in the GH-deficient group than in the control group, but was greater than the mean concentration in age-matched prepubertal GH-deficient patients. Four GH-deficient patients were treated with a potent agonist of LRF. This caused suppression of gonadal sex steroid concentrations and a fall in mean height velocity from 9.1 to 4.3 cm/yr after 1 yr of therapy; however, circulating GH and IGF-I values were not uniformly altered. We conclude that a substantial pubertal growth spurt can occur in patients with true precocious puberty and GH deficiency that is dependent on gonadal sex steroids yet unaccompanied by normal pubertal levels of circulating GH or IGF-I. Reversal of this growth acceleration is possible with sex steroid suppression. The results, in light of previous in vivo and in vitro studies, suggest that the normal pubertal growth spurt is mediated in part by direct effects of sex steroids at the growth plate.

Age Determination by Skeleton↗

PubMedDate not supplied

Fracture of the cuboid in children: case report and review of the literature.

Although fractures of the cuboid are rare, they can be very disabling. The diagnosis is often missed, and overlooked cuboid fractures can lead to severe alterations in foot mechanics and function. We report the case of a displaced compression fracture of the cuboid in an 8-year-old girl after a fall from a height, which we treated by open reduction, bone grafting, and internal fixation. Follow-up examination 2 years after the injury revealed a very good result. Cuboid fractures should be considered in the differential diagnosis of limping toddlers. Children seen with pain, swelling, and inability to bear weight on the lateral aspect of the foot require proper evaluation and treatment.

Accidental Falls↗

PubMed2002

Accidental injuries in agriculture in the UK.

The rate of occupational accidents in British agriculture is higher than in most other industries. The most common fatal accidents are those involving vehicles and machinery, falls from a height and electrocution. A substantial proportion of reported non-fatal injuries in agricultural employees is attributable to manual handling, but among self-employed farmers the contribution is much smaller. Few data are available on longer-term determinants of risk, but accidental deaths are most frequent in July, August and September. The main approaches to preventing agricultural accidents are through engineering improvements, and education and training of the workforce. The introduction of roll-over protection structures for tractors has been an important development in recent decades. Other engineering controls include guards for power take off shafts, guard rails to prevent falls, better handling facilities for animals and closed transfer systems for pesticides. Training on safety is available from several sources, but its effectiveness in reducing accidents is uncertain.

Accidents, Occupational↗

PubMedDate not supplied

[Cervical findings and petechial hemorrhages in falls from high positions].

Cases of combined suicide are infrequent findings, especially cases in which each method can be lethal. In interpretation of cases with a multitude of serious injuries it might be impossible to discover minor injuries which had occurred in the course of a preceding confrontation, because they may be masked by the general traumatization. In two cases of suicidal fall from a height neck injuries and petechial bleedings were found. The first case (woman 53 years) was a combination suicide (strangulation by ligature, deep incisions into her wrists, jump out of the window). The intensive petechial bleedings in the face could be explained as a result of ligature strangulation and the fracture of a lower thyroid horn as an indirect fracture resulting of the head traumatization. In the second case (girl, 14 years) petechial bleedings in the face were found. Furthermore the victim had marks on her neck-skin, consisting of well-lined bleedings and scratches, presenting a clear pattern, which could be related to a necklace. An explanation of these injuries as a result of a direct impact could not be given. Something must have happened prior the fall. Informations concerning the last hours before her suicide could not be obtained but a strangulation-attempt (by herself? by others?) must be ascertained. The histological investigation of the skin of this region arised a negative vital reaction, therefore a very short interval between that event and the death was assumed.

Adolescent↗

PubMed2006

Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation.

Fifty patients with thoracolumbar fractures were treated operatively between July 2000 and December 2001. The average age of the patients was 33.6 years (range: 20-50 years), 36 were males and 14 were females and the follow-up averaged 59 months (range: 49-68 months). A fall from a height, usually a tree, was the most common cause of injury. Twenty six patients had unstable burst fractures and 13 had translational injury. There were 15 patients with complete neurological deficit, 17 had partial neurological lesions, while 18 had no neurological deficit. All patients were treated by posterior short segment fixation (Steffee VSP). The average pre-operative kyphotic angle was 21.48 degrees , which improved to 12.86 degrees in the immediate post-operative period. The loss of kyphosis averaged 3.46 degrees (0-26 degrees ) at the final follow-up. The average pre-operative anterior vertebral body height was 44.7% (range: 36-90%), which improved to 72.0% (range: 55-97%) in the immediate post-operative period. The loss of body height averaged 3.0% (range: 1-15%) at the final follow-up. No neurological deterioration was seen, and in 24 cases a one grade or better improvement was observed. The mean pain score was 1.6, and the mean functional score was 2.8. We found that the application of posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; there were, however, significant other complications.

Accidental Falls↗

PubMed2002

Isolated extradural hematoma in children presenting to an emergency department in Australia.

BACKGROUND: Isolated extradural hematoma (EDH) is becoming more frequently recognized in emergency departments (EDs) in children. We describe the natural history of children with isolated EDH presenting to a large Children's Hospital ED. METHODS: This is a descriptive case series study using a retrospective review of the medical records of children presenting to the ED with a diagnosis of isolated EDH over 8 years. Comparison was made with children having other injuries in addition to EDH. The cause, nature of injury, presentations to hospital, management, outcome, and any association with nonaccidental injuries (NAI) were analyzed. RESULTS: Of the 35 cases with a final diagnosis of isolated EDH initially presenting to the ED, 70% were over 3 years of age (mean 6.6 years), and 60% were boys. A fall of less than half a meter was the cause of isolated EDH in 51.4% of patients. The remaining cases resulted from a fall from a height greater than half a meter (17.1%), a motor vehicle accident (11.4%), being hit by an object (8.6%), a bicycle accident (5.7%), and a skateboard accident (5.7%). Children younger than 3 years presented within 24 hours of injury in 70% of cases, compared with 65% of older children. In 95% of cases, presentation was nonspecific, suggesting a medical rather than a surgical problem. This resulted in a delay in seeking emergency care and a delay in final diagnosis for these patients. Surgical drainage was required in 68.6% of cases, with older children being more likely to be managed conservatively. In 23.4% of cases, minor residual neurologic deficit occurred; there were no cases of serious long-term problems. There were no cases of NAI in the children studied. CONCLUSION: This report highlights falls as a common cause of isolated EDH in children. Delay in presentation for clinical assessment is common, because many children have nonspecific presentation that is suggestive of a medical problem. No cases of NAI were reported in this study.

Accidents↗

PubMed1990

[Results of the treatment of fracture of the odontoid process of the axis].

At the Rehabilitation Institute in Konstancin there were 80 patients treated due to the fracture of the dens epistrophei within the years 1970-1986. In all the cases the fracture was within the base of the dens. More than 50% of the patients were over 50 years of age at the time of injury. On admission about 34% of patients had neurological disturbances of various degree manifested by paresis of the extremities. The leading cause of spine injury were falls from a height (60%), particularly from a horse-cart. In 55% of cases the injury was through extension mechanism. Surgical treatment was applied in 35 cases (29 cases of posterior fusion of CI-C1I by bone grafting and wire loop, 6 cases of axis dens and vertebral body CI1 fixation by AO screw, by Böhler method). The remaining 45 cases were conservatively treated. The paper presents the radiological results of conservative and surgical treatment as well as an analysis of the neurological recovery.

Accidental Falls↗

PubMed1990

[Spinal injuries in accidental falls].

The case histories of 247 patients with spinal damages caused by a fall from a height are analysed. In 180 (75.3%) patients the damage to the spine was combined with traumas of other localization. The author emphasizes the specific features of the diagnosis and the tactics of management of patients with trauma attended by multiple and concurrent injuries and calling for physicians of allied specialties to take part in the examination and treatment. The methods of treatment of spinal damages are chosen strictly individually and are combined with nonoperative or operative management of injuries to other parts of the skeleton.

Accidental Falls↗

PubMed1999

Epidemiological study of hip fracture in Shenyang, People's Republic of China.

The aim of this study was to investigate the incidence and epidemiology in 1994 of hip fracture in Shenyang, a large city in the northeast of The People's Republic of China, using register information and medical records collected from the 36 hospitals in Shenyang. The hip fracture data were restricted to cervical or trochanteric types. A subset (59% of total) of medical records of hip fracture was used to investigate the causes of hip fracture. The causes were classified as simple fall, fall from a bicycle during cycling, bicycle accident, car accident, and fall from a height. There was a total of 453 hip fractures (206 in women and 247 in men) in the population over 50 years of age. The age-adjusted 1 year cumulative incidence rate was 67/100,000 (95% confidence interval [CI] = 58-76/100,000) for women and 81/100,000 (95% CI = 71-91/100,000) for men. The standardized incidence rate against the 1985 U.S. population was 87/100,000 (95% CI = 77-97/100,000) for women and 100/100,000 (95% CI = 89-111/100,000) for men. The mean (+/-standard deviation) age of patients with a hip fracture was 67.5+/-9.8 years for men and 66.9+/-9.0 years for women. The overall male-to-female ratio of hip fracture was 1.21:1 for age-adjusted hip fracture incidence and 1.15:1 for standardized incidence. Simple fall accounted for 70% hip fractures in women but caused only 49% in men (chi2 = 11.2, degrees of freedom [df] = 1,p = 0.0008). The frequency of hip fractures caused by a fall from a bicycle was higher in men (28%) than women (10%) (chi2 = 13.0, df = 1,p = 0.0003). The results of this study indicate (1) a low incidence of hip fracture in a Chinese population compared with more affluent countries, and (b) a higher incidence in men than women that is related in part to a higher incidence of accidents, especially bicycle-related ones.

Accidental Falls↗

PubMed1995

Tarsometatarsal (Lisfranc's) injuries--results of open reduction and internal fixation.

Injuries of the tarsometatarsal (Lisfranc's) joint are uncommon and are potentially associated with chronic disability. The aim of our study was to review retrospectively the results of open reduction with Kirschner wire internal fixation of tarsometatarsal injuries. In this study, 12 patients with Lisfranc's injuries treated between January 1986 and March 1993 were reviewed at an average of 36 months after the injuries. Majority of the patients suffered from type B injuries (Hardcastle's classification, 1982). There were 9 closed and 3 open injuries. All were high energy injuries sustained in motor vehicle accidents, fall from a height or crush force. All were treated with open reduction and internal fixation with Kirschner wires. Anatomical reduction was achieved and maintained. There was no postoperative redisplacement. During follow-up, most patients developed radiological evidence of post-traumatic osteoarthritic changes. However, majority of the patients were pain-free or had very little foot pain, and were able to return to their previous occupation. Our study showed that open reduction with Kirschner wire internal fixation offered satisfactory anatomical and functional results.

Accidental Falls↗

PubMed1990

Home accidents to children under 2 years of age.

Within a population-based register of childhood injuries, 641 home accidents to children aged under 2 years were recorded in six hospitals. The annual rate was higher in children over 1 year (6.6 per 100) than in infants (2.7 per 100). A male predominance was observed only after the first birthday. Most injuries were related to physical trauma (mainly falls), but burns and poisonings were frequent in the second year. Most lesions were benign, except in the case of falls from a height (from a window or baby furniture). Nineteen per cent of the children were admitted to hospital. There were 15 skull fractures, two fatal cases and two severe sequelae. Child abuse was seldom suspected and the reasons for this are discussed. The study of the circumstances in which accidents occur leads to the conclusion that the main aspect of prevention should be passive protection ensured by the creation of a safe environment (compulsory safety standards for baby furniture, child resistant packaging), but that parents' information and education should also be developed, with emphasis on knowledge of children's normal psychological and motor development and abilities.

Accidental Falls↗

PubMed2001

The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol.

The management of intra-articular calcaneal fractures remains controversial with strong arguments supporting both conservative and operative management. This study assesses the results of open reduction and internal fixation (ORIF) of displaced intra-articular fractures of the calcaneum in two independent centres where the indications for operative management had been strictly defined.Forty-seven patients (51 fractures) who had sustained such injuries underwent an ORIF performed by one of the senior surgeons using the technique described by Eastwood et al. [JBJS 75-B(1993)189] All of the fractures were assessed by plain X-ray and CT scan and graded according to the Sanders classification [Clin. Orthop. 290(1993)97]. Patients were assessed at a minimum of 2 years post-surgery both clinically and with a standardised questionnaire based on that described by Kerr et al. [Injury 27(1996)35]. The mean age at operation was 42 and 50 years for the two centres, and the mean follow-up was 44 months. Seventy-six per cent of the patients were male. Eighty-eight per cent of the injuries were due to a fall from a height. Fifteen patients had contralateral foot/ankle injuries. Thirty-four of 46 patients were in employment at the time of the injury, 24 of these were in physical jobs and 20 sustained their injury whilst at work.Overall, the satisfaction rate was 90%. Ninety-four per cent of patients in work returned to work at a median of 6 months. Bilateral injuries were associated with a significantly poorer outcome as were those with heel pad pain. Delay to operation greater than 14 days was associated with a higher infection rate. Smoking was not related to infection rate.

Accidental Falls↗

PubMed2005

Comparison of two surveys of head injured patients presenting during a calendar year to an urban medical centre 32 years apart.

OBJECTIVE: To study the patients presenting with head injuries to a tertiary hospital in Karachi during the year 2003. METHODS: During the calendar year 2003, a cross-sectional study was conducted of all patients presenting to the casualty department of Jinnah Postgraduate Medical Centre (JPMC) with head injury. Personal information was collected from the patient's attendants at presentation or later if the patient had been brought in by the emergency services as an unknown person. The circumstances of the injury were similarly established and the clinical features documented. RESULTS: During the year 2003, a total of 3008 patients reported to the emergency room of JPMC. Of these 67% were males and the majority of the reporting patients (48%) had suffered their head injury in falls from a height. However, when considering the seriously injured patients warranting admission to the neurosurgery unit, road traffic injuries predominated (54%) and the age distribution was weighed towards an older age group with 70% being above the age of 20 years and mainly in the economically active 4th decade of life. One hundred and fifty four patients died for a mortality rate of 5% in the entire series of 3008 patients and 25% of the 623 admitted patients. CONCLUSION: The experience of head injuries reporting to our centre in two calendar years, 33 years apart, suggests that this attention to the crisis of death and disability occurring on roads is necessary.

Accidental Falls↗

PubMed1997

[The epidemiology of multiple trauma].

Trauma is the leading cause of death for people up to 40 years of age in Germany. Most of the patients were injured in traffic accidents where special injury patterns could be detected: head injuries in bicycle and pedestrian accidents, lower extremity injuries in motorcycle accidents, and chest and pelvis injuries in car accidents. After falls from a height, the most common injuries were fractures of the thoracic and lumbar spine. The treatment of polytrauma patients requires high health care resources and demands sophisticated medical support. It is estimated that every trauma patient costs daily approximately DM 4,700. It is not only the acute medical care that burdens our social system, but also the long period of rehabilitation and reintegration. The number of preventable trauma deaths can be significantly reduced in special trauma centers, and the high costs could be damaging for smaller hospitals. A plea is made for more preventive measures and legislative changes to reduce the number of traffic accidents. The medical care of trauma patients should be in special trauma centers.

Accidental Falls↗

PubMedDate not supplied

Optic nerve injury in children. A prospective study of 35 patients.

Thirty-five children under 15 years of age with optic nerve injury are prospectively studies for their clinical presentation, radiological findings, visual evoked potentials and outcome. Over 50% were under 10 years of age. In half of the children, injury was due to fall from a height. Fracture of the skull was recorded in a third of the patients, and optic canal fracture was seen only in three children. Visual Evoked Potentials (VEP) were record in 30 children and were repeated several times in first three weeks. All the patients received corticosteroids and optic canal decompression was not carried out routinely. Overall spontaneous visual recovery was observed in 12 patients. Among the 30 children in whom Veps were recorded, 17 children had repeatedly absent VEP, and none of the children showed wave formation, 10 (77%) had visual recovery. Only in 5 patients an optic canal decompression was carried out several weeks after injury. This study brings out the role of VEP in children with optic nerve injury.

Accidental Falls↗