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PubMed1994

Mode, presentation, CT findings and outcome of pediatric head injury.

Twenty five to thirty per cent of all patients admitted with head injuries to any large hospital are children. Head injuries in children differ in several ways from those seen in the adult population. A standard management protocol is used in a service hospital and CT and neurosurgical consultation/transfer is based on specific criteria. The records of 312 patients admitted with head injury to Command Hospital (WC), Chandimandir were retrospectively analysed to compare the mode of injury, initial presentation, CT findings and the outcome of management between those above and those below the age of 10 years. Eighty seven (27.8%) of the 312 patients were children and 71% of them had sustained the injury due to fall from a height. One third of children were brought with vomiting and drowsiness and 9.2% with seizures, but lateralizing signs were found in only 5.7%. Nineteen children underwent a CT of the head and of these 74% had only cerebral edema. Only 4 of the 87 children were transferred to a neurosurgical unit. The mortality rate was lower in children (5.7%) compared to the older age group (11.6%) but the difference was not statistically significant. However, a significantly higher number (80.5%) of children recovered without any residual deficit. Majority of our children can be safely managed in a general surgical unit provided a multidisciplinary approach is used and facilities of CT are readily available, since very few require active neurosurgical intervention.

Accidental Falls↗

PubMed2005

Acetabular fractures: a 16-year prospective epidemiological study.

We prospectively analysed the epidemiology of acetabular fractures over a period of 16 years in order to identify changes in their incidence or other demographic features. Our study cohort comprised a consecutive series of 351 patients with acetabular fractures admitted to a single institution between January 1988 and December 2003. There was no significant change in the overall incidence of acetabular fractures, which remained at 3 patients/100 000/year. There was, however, a significant reduction in the number of men sustaining an acetabular fracture over the period (p < 0.02). The number of fractures resulting from falls from a height < 10 feet showed a significant increase (p < 0.002), but there was no change in those caused by motor-vehicle accidents. There was a significant reduction in the median Injury Severity score over the period which was associated with a significant decrease in mortality (p < 0.04) and a reduction in the length of hospital stay. The incidence of osteoarthritis noted during follow-up of operatively-treated fractures declined from 31% to 14%, reflecting improved results with increasing subspecialisation. Our findings suggest that there will be a continuing need for some orthopaedic surgeons to specialise in the management of these fractures. In addition, the reductions in the Injury Severity score and mortality may be associated with improved road and vehicle safety.

Accidental Falls↗

PubMed2007

[The dorsal spondylodesis of rotationally unstable thoracic fractures. Is additional ventral stabilization necessary?].

METHODS: A total of 60 patients with solely dorsally reconstructed type C fractures of the thoracic spine admitted between January 2000 and December 2003 were retrospectively evaluated. Stability was determined by measuring kyphosis of the vertebral body, the operated segments and of lateral bending on the basis of plain films and computed tomography immediately postoperatively and after 2 and 19 months. RESULTS: There were 48% C2, 38% C1 and 13% C3 fractures. Of the injuries, 28% were caused by motorbike accidents, 25% by car accidents, 23% by falling from a height, 13% by suicidal jumps, 3% by ski accidents and 3% for other reasons. A total of 92% of the patients had severe thoracic trauma as attendant injuries, 42% further vertebral fractures, 35% a head injury, 30% an extremity fracture, 15% a clavicle fracture, 8% an abdominal trauma and 7% a fractured pelvis. At 19+/-12 months postoperatively, the angle of the operated segments increased by 4.7 degrees +/-4.0 degrees and that of lateral bending of the operated segments by 0.7 degrees +/-1.8 degrees compared to the immediate postoperative values. CONCLUSION: In spite of the high instability of the injured spine, the collective examined had no relevant postoperative loss of correction and no increase in lateral bending. Therefore, a solely dorsal reconstruction is sufficient, reasonable and economical.

Abdominal Injuries↗

PubMed1989

Orbital roof fractures in childhood.

The authors documented 36 orbital roof fractures in 32 children over a 5-year period. With the aid of computed tomography (CT), 16 fractures were classified as isolated and 20 were found to be associated with more extensive damage to the skull. Isolated fractures typically occurred in younger children (mean age, 2.8 years) after relatively minor trauma, most often a fall from a height of less than 10 feet. Birth trauma was the cause in one case. Three fourths of the isolated fractures were linear; with extensive trauma, the orbital roof was usually comminuted. Upper eyelid hematoma characteristically developed hours after the traumatic event. There were no significant chronic disturbances of vision, motility, or lid function. Acute neurologic concerns were common, and two patients died, but full recovery was otherwise the rule. In two cases, late development of ocular pulsation led to CT demonstration of encephaloceles. Both of these children had comminuted roof fractures with displacement of bone fragments into the orbit. The authors conclude that fracture of the orbital roof is a common but frequently overlooked occurrence in childhood. Anatomic factors may account for differences in the effect of frontal impact at different ages.

Accidental Falls↗

PubMed1993

Acute injuries of the upper dorsal spine.

In an effort to define better diagnostic and treatment criteria, we reviewed the cases of 50 patients with injuries of the upper dorsal spine from T2-T9, seen between January 1983 and July 1988. The majority of injuries were caused by road traffic accidents, followed by falls from a height, and train accidents. More than 50 per cent had associated injuries, of which four were missed; 50 per cent had neurological deficits, and the majority of these cases had burst fractures and fracture-dislocations. Treatment was non-operative in the majority of cases, with only four cases undergoing anterior spinal decompression and fusion, and one had posterior instrumentation and fusion. At follow-up (1-3 years), only one patient, a child, had significant deformity. All patients with partial neurological deficit improved, whereas none of those with complete neurological lesions recovered. Five patients had significant back pain requiring analgesics but not significant enough to interfere with their activities. We concluded that most of these injuries are stable and should be treated non-operatively. Surgery is only indicated in cases with partial neurological deficit and significant spinal canal compromise or significant instability. Children should be followed up until maturity to look for late deformity.

Accidental Falls↗

PubMed1995

Blunt rupture of the diaphragm. A retrospective analysis of 41 patients.

Forty-one patients with multiple injuries together with diaphragmatic rupture due to blunt trauma were reviewed. The rupture was caused by a motor vehicle accident in 29 (71%) and falling from a height in four (10%) patients. A chest X-ray on admission suggested the diagnosis in 70% of the cases. Small bowel herniation did not occur in ruptures smaller than 15 centimetres. All patients had associated injuries and 84% suffered intra-abdominal trauma, most commonly splenic rupture (42% of all patients). 15 out of 18 patients with a concomitant rupture of the spleen were injured in automobile accidents. The occurrence of splenic rupture in patients injured in automobile vs other accidents differed significantly (P = 0.027). The mortality rate was 12%. Mortality and most of the complications were related to associated injuries. We conclude that 1) there is a high occurrence of intra-abdominal injuries, especially splenic ruptures, in patients with rupture of the diaphragm, 2) the occurrence of splenic rupture is higher in patients injured in automobile accidents than in patients injured by some other mechanism, and 3) a chest radiograph on admission is the best diagnostic aid.

Accidental Falls↗

PubMed2002

Osteoporosis with underlying connective tissue disease: an unusual case.

A 44-year-old male was initially seen by dermatologists, who noted an erythematous rash on sun-exposed areas, the back, shoulders, and upper arms. There was associated muscle weakness and significant weight loss. Investigation revealed mildly raised aspartate and alanine transaminases but normal creatine kinase. Inflammatory indices and antinuclear antibodies (ANAs) were normal. Biopsy of the rash was reported as consistent with either dermatomyositis (DM) or acute lupus erythematosus. A diagnosis of DM was made, and prednisolone was given with improvement of the rash but deteriorating myopathy. The patient was referred to the rheumatology department, and further history revealed multiple vertebral fractures after falling from standing height; these had occurred six months prior to starting steroids. Besides smoking he had no other risk factors for osteoporosis. Examination showed normal muscle strength, no muscle tenderness, and no joint abnormality. Repeat muscle enzymes were normal, and ANAs were now 1 : 100, but dsDNA antibodies and extractable nuclear antigens were normal. Investigations for osteoporosis revealed a hypergonadotrophic hypogonadism picture. Further examination indicated scanty pubic and auxiliary hair, small testicles, and mild gynecomastia. He is married, though has no children of his own. The hormonal profile raised the possibility of Klinefelter's syndrome, which was subsequently confirmed with karyotyping of 47 XXY. Hypogonadism has been established as a cause of osteoporosis in males, and in this case would explain the occurrence of fractures in the absence of other major risk factors. Systemic lupus erythematosus has been recognized in association with Klinefelter's syndrome; in view of the normal muscle enzymes, his rash is most likely due to acute discoid lupus with androgen deficiency causing muscle weakness.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2004

Hospital-treated minimal-trauma rib fractures in elderly Finns: long-term trends and projections for the future.

We determined the current trends in the number and incidence of hospital-treated minimal-trauma rib fractures (low- to moderate-energy traumas typically caused by a fall from standing height or less) in Finnish elderly people by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to hospitals in 1970-2001 for primary treatment of such fractures. The number and incidence (per 100,000 persons) of these fractures clearly increased from 268 (number) and 41 (incidence) in 1970 to 737 and 70 in 2001, while in younger patients (aged 20-49 years) the trend was decreasing, the corresponding numbers being 194 and 10 in 1970, and 153 and 7 in 2001. In the elderly Finns, also the age-adjusted incidence of these hospital-admitted rib fractures showed an increase, from 37 (1970) to 51 (2001) in women, and from 63 to 77 in men. In women aged 80 years and over, the age-specific incidence of fracture increased from 88 to 186, while in the other age groups only slight secular changes were found. If the above-described trends continue, the number of elderly Finns admitted to a hospital due to a rib fracture will more than double in next three decades.

Accidental Falls↗

PubMed2004

Traumatic rupture of the ligamentum teres as a source of hip pain.

PURPOSE: Lesions of the ligamentum teres have only occasionally been reported in the literature. However, with arthroscopy, pathology of the ligamentum teres has been increasingly recognized. The purpose of this article is to report the clinical characteristics associated with rupture of the ligamentum teres and the results of arthroscopic treatment. TYPE OF STUDY: Case series study. METHODS: All patients undergoing hip arthroscopy have been prospectively assessed using a modified Harris Hip score (100 point maximum) obtained preoperatively and postoperatively at 3, 12, 24, and 60 months. In this study, 271 cases had at least 1 year of follow-up evaluation. From this population, 41 patients were identified with lesions of the ligamentum teres. Twenty-three of these were traumatic in origin and represent the substance of this study. The remainder (18) were hypertrophic or degenerative. RESULTS: We noted 100% follow-up at an average of 29.2 months. Patients included 14 women and 9 men with an average age of 28.3 years. Duration of symptoms before surgery averaged 28.5 months. All patients experienced deep anterior groin pain. Nineteen patients experienced mechanical symptoms (catching, popping, locking, giving way), and 4 patients described simply pain with activities. Fifteen patients sustained major trauma (7 motor vehicle accidents, 3 falls from a height, 3 football, 1 snow skiing, 1 ice hockey), including 6 dislocations. The remaining 8 patients sustained a twisting injury. Evaluation included 20 magnetic resonance imaging (MRI) scans, 7 MR arthrograms, 7 computed tomography (CT) scans, and 3 bone scans. The diagnosis of a lesion of the ligamentum teres was made preoperatively in only 2 cases. Rupture of the ligament was complete in 12 cases and partial in 11. Ligament injury was an isolated finding in 8 cases, and associated pathology was found in 15 cases (9 labral tears, 5 loose bodies, 5 chondral damage). The average preoperative score was 47, and postoperative score was 90. No statistical difference was seen based on type of injury, complete versus partial rupture, or presence of coexistent pathology. CONCLUSIONS: Rupture of the ligamentum teres is increasingly recognized as a source of persistent hip pain. The diagnosis remains elusive to various imaging techniques. An index of suspicion should be maintained, especially in the presence of mechanical symptoms and a history of significant trauma. However, rupture may occur simply from a twisting injury in absence of major trauma. These lesions can be diagnosed using arthroscopy and, based on these results, may respond remarkably well to arthroscopic debridement. LEVEL OF EVIDENCE: Level IV.

Accidental Falls↗

PubMed2002

External and iatrogenic trauma of the urinary bladder: a survey in Poland.

OBJECTIVE: To assess incidence of urinary bladder injuries (frequently associated with pelvic trauma and often iatrogenic) in Poland. MATERIALS AND METHODS: The records and details of urinary bladder injuries treated between 1995 and 1999 were analysed for 61 urological departments in Poland. RESULTS: During the 5-year period 512 patients had urinary bladder injuries; in 210 (41%) the injury was caused by a road traffic accident, in eight (2%) by compression (crushing injury) within the limits of the pelvic bones, in 40 (8%) by a fall from a height, in three by a gunshot wound and in the remaining 251 (49%) the injury was iatrogenic. Among the 261 bladder injuries that were not iatrogenic, 41 (16%) were associated with pelvic bone trauma. In 36 patients there was simultaneous injury of the urinary bladder and posterior urethra, constituting 14% of such injuries and 7% of all trauma cases. The iatrogenic injuries were in 98 patients (39%) in urological departments, in 130 (52%) women in gynaecological departments and in 23 (9%) on surgical wards. The injury was open in 102 patients (20%) and closed in 372 (73%); there was bladder contusion in 38 patients (7%). The injuries were intraperitoneal in 225 patients (44%) and extraperitoneal in 287 (56%). For diagnosis, abdominal ultrasonography was used in 455 (89%) patients, intravenous pyelography in 266 (52%), cystography in 388 (76%) and computed tomography in 15 (3%). The delay between trauma and diagnosis was 0.5-124 h. Surgical treatment of the injury comprised a monolayer suture of the bladder wall in 51 patients (10%), a two-layered suture in 461 (90%), perivesical drainage in 468 (91%) and inspection of the peritoneal cavity in 232 (45%). The mean (range) interval between diagnosis and treatment was 14 (7-70) days. Seven patients died after the treatment failed. CONCLUSIONS: Almost half the patients had iatrogenic injuries, of which over half occurred in gynaecological and maternity wards. Thus it is important teach the basic range of urological operations to trainee doctors. The commonest diagnostic method was not ascending cystography but ultrasonography; we recommend ascending cystography be used with at least two views after filling the urinary bladder with approximately 300 mL of contrast medium, with an additional film after emptying the contrast medium. In patients with pelvic bone trauma it is reasonable to use spiral computed tomography with virtual analysis before surgery. A two-layered suture of the bladder wall with perivesical drainage should be used.

Accidental Falls↗

PubMed2002

Osteoporosis intervention following distal forearm fractures: a missed opportunity?

BACKGROUND: Fractures are a manifestation of osteoporosis, but therapeutic interventions to reduce the risk of recurrent fractures are not widespread. OBJECTIVE: To identify predictors of osteoporosis treatment in postmenopausal women following distal forearm fracture. METHODS: This population-based retrospective cohort study included all postmenopausal women, 45 years or older, residing in Olmsted County, Minnesota, who sustained a distal forearm fracture due to minimal trauma (a fall from standing height or under) in 1993 to 1997. Complete medical records were reviewed for each subject and Cox proportional hazards regression was used to evaluate the relationship of baseline demographic and clinical characteristics to therapeutic interventions for osteoporosis within 12 months following the fracture. RESULTS: A total of 343 women with a mean age of 70.5 years had a minimal trauma distal forearm fracture. Within 12 months, 83% had seen a nonorthopedic physician. Of these, 17% had a pharmacologic osteoporosis intervention and the 12-month actuarially estimated cumulative incidence of any intervention was 18% (95% confidence interval [CI], 14%-22%). In a multivariate analysis, treatment was more likely to be offered to those with a prior diagnosis of osteoporosis (relative risk [RR], 2.08; 95% CI, 1.21-3.58), previous distal forearm fracture (RR, 2.38; 95% CI, 1.30-4.34), or history of cigarette smoking (RR, 1.86; 95% CI, 1.11-3.12). CONCLUSIONS: Effective osteoporosis interventions are underutilized among postmenopausal women who experience an osteoporotic fracture. Further work is needed to overcome barriers to optimal osteoporosis management in these women who are at high risk for future complications of osteoporosis.

Cohort Studies↗

PubMed1993

Early anterior decompression and fusion for crush fractures of cervical vertebrae.

From 1965 to 1991, 273 patients with crush fractures of cervical vertebrae were treated. They were sustained by young people in diving accidents, road accidents, or falls from a height. Spinal cord involvement with a varied degree of tetraplegia was usually present. The results of management by nonoperative or operative means have been compared. There has been neurological improvement in 14% of nonoperative and 44% of operative cases. Early surgical decompression by an anterior approach with stabilization by a bone graft is advocated to improve outcome and reduce the time in hospital.

Activities of Daily Living↗

PubMed1985

[Pulmogenic air embolism].

Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction.

Accidents↗

PubMed1996

Features of pediatric head injury in Hong Kong.

Head injury in children causes special concern in most communities. From 1989 to 1994, 2,785 children younger than 16 years old were admitted to our neurosurgical service because of head injury. Fall from a height was the major cause of head injury leading to admission in infants and children in preschool age groups, whereas traffic-related or bicycle-related accidents were more likely to be the cause of head injury for those aged 11-15 years. In all age groups there was a male preponderance. The overall mortality was 0.6%. Traffic-related accidents caused more severe injury and accounted for 67% of all fatalities. For patients under 6 years old, about 40% of head injuries occurred at home. Preventive measures for pediatric head injury in Hong Kong are suggested.

Adolescent↗

PubMed1983

Relationship between isokinetic performance and ballistic movement.

The present experiments were carried out to assess the relationship between the mechanical behaviour of the leg extensor muscles in 12 male athletes during activities of a ballistic type and torque production, during: (1) torque production during isokinetic contraction: (2) ballistic type activities (vertical jumps from statis position = SJ, with counter-movement equal CMJ and after a fall from different heights equal DJ) and (3) a new anaerobic test (Bosco 1983a). This consisted of performing continuous jump work for a certain period of time (e.g., 60 s). Both ballistic activities and anaerobic power tests demonstrated the highest relationship with peak torques when this was developed respectively at pi and 4.2 rad x s-1. Peak torque was related to SJ (r = 0.71, p less than 0.01); to CMJ (r = 0.74, p less than 0.005); to best DJ (r = 0.60, p less than 0.05), to 15 s anaerobic power (r = 0.70, p less than 0.01) and 60 s anaerobic power (r = 0.68, p less than 0.01). The power output during ballistic activities was much higher than the power measured during zero acceleration performances. The difference noted was explained in the light of the fact that, when jumping, three different extensor muscle groups in each leg contract with re-use during the concentric phase of elastic energy stored during the eccentric phase. The relationship between isokinetic contraction and ballistic motion is discussed in terms of fiber type recruitment and their velocity dependency.

Acceleration↗

PubMed1989

Post-traumatic intradiploic pseudomeningocele in children.

Eight children with post-traumatic pseudomeningocele are reported. In this paper the mean age at the time of injury was one year and ten months. All of them gave a history of a fall from a height. In six patients the meningocele was located in the parieto-occipital region. The frontal bone was involved in one and the roof of the orbit in another. All these patients had localized progressive swelling of the skull associated with a bony defect. Four patients had a history of convulsion and three had hemiparesis. The meningocele was excised, the dural defect repaired and a cranioplasty was performed in all. Good recovery was observed in all of them.

Adolescent↗

PubMed1997

Growing skull fractures: a clinical study of 41 patients.

Growing skull fractures are rare complications of head injury, occurring almost exclusively in infants and children under the age of three. A retrospective review at our Institute yielded 41 patients with this entity over a period of 20 years (1975-1995). The age at presentation ranged from less than 1 year to 62 years, with 33 (80.5%) patients being less than 5 years of age. The cause of injury was either a fall from a height (93%) or a road traffic accident. The most common location of a growing skull fracture was either parietal or frontoparietal (56%). One patient had a posterior fossa growing skull fracture. CT scan was performed in 19 patients which demonstrated an underlying porencephalic cyst, hydrocephalus or a cyst communicating with the ventricle. In 5 children, a ventriculo-peritoneal shunt alone was performed. Twenty four patients underwent a duro- and cranioplasty while a duroplasty alone was performed in 8 patients. The material used for cranioplasty included acrylic, wire mesh, steel plates or autologous bone. Three patients died, one due to an anaesthetic complication and two as a result of postoperative meningitis. Post-operative CSF leaks occurred in 3 patients, which were managed by a lumbar drain. Six patients had local wound infection.

Adolescent↗

PubMed1997

The number and incidence of minor trauma knee fractures are increasing in elderly women but not in elderly men.

To improve knowledge of the current trends in the number and incidence of age-related minor trauma knee fractures, we selected from the National Hospital Discharge Register all patients 60 years old or older who were admitted to Finnish hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985, 1988-1989 and 1991-1994 for primary treatment of first knee fracture. The knee fracture was defined to be a "minor trauma" fracture if it had occurred as a result of a fall from standing height or less. We also predicted fracture development until the year 2020 by a regression model, which took into account the predicted changes in fracture incidences and population at risk. The number and incidence (per 100,000 persons) of minor trauma knee fractures in Finnish women aged 60 years or more clearly increased during the study period, from 219 (number) and 55 (incidence) in 1970 to 579 and 100 in 1994. Women's age-adjusted incidence of these fractures also showed an increase, from 58/100,000 in 1970 to 93/100,000 in 1994. If this trend continues, there will be about 2 times more minor trauma knee fractures in Finnish women in the year 2020 than there were in 1994. In Finnish men aged 60 years or more the absolute numbers and incidences of these fractures did not show consistent trend changes over time. We conclude that the number of minor trauma knee fractures in elderly Finnish women in increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures should urgently be adopted to control the increasing burden of these age-related fractures.

Age Distribution↗