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PubMed2006

Carpal dislocations.

Carpal dislocations are rare but devastating injuries. They most often occur from high-energy trauma such a motor vehicle accidents, falls from a height, or industrial-related accidents. Encompassing a spectrum of pathology, these injuries include perilunate dislocations, transcarpal fracture-dislocations, radiocarpal dislocations, axial or longitudinal dislocations, and the rare isolated carpal bone dislocations. A thorough understanding of the carpal anatomy, injury patterns, and treatment options is critical for proper management of these serious injuries. In this article, the authors address the five main categories of carpal dislocations, the associated anatomy, and their diagnosis, treatment, and prognosis.

Carpal Joints↗

PubMed2005

Improvement in initial survival of spinal injuries: a 10-year audit.

A 10-year retrospective study of all spinal injuries presenting to the Leeds Teaching Hospitals between 1991 and 2001. The hospitals provide secondary care to a population of 750,000 and tertiary care to a population of 2-3 million. In total 1119 spinal injuries were studied. The overall survival rate was 89%. The commonest age group for presentation was 25-29 years with a secondary peak in the seventh decade, a mean overall of 43 years. 66% of injuries occurred in males. The commonest cause was a fall from a height (44%), with road traffic accidents (RTA) causing 43%. Pedestrians were most at risk within the road traffic group, making up 63% of cases. Isolated cervical spine injuries made up 37% of all cases. Cervical fractures were most associated with neurological injury (50%). Immediate survival has increased over the decade from 83% in 1991 to 93% in 2001. The probability of survival was significant at P = 0.006 and actual survival at P = 0.012 (Pearson correlation). The causal analysis has not been carried out but it is thought likely that improved quality of care is responsible.

Adolescent↗

PubMed2004

Feline high-rise syndrome: 119 cases (1998-2001).

High-rise syndrome was diagnosed in 119 cats over a 4-year period. 59.6% of cats were younger than one year, and the average height of the fall was four stories. High-rise syndrome was more frequent during the warmer period of the year. 96.5% of the presented cats, survived after the fall. 46.2% of cats had fractured limbs; 38.5% of fractures were of the forelimb, 61.5% of the hindlimb. The tibia was fractured most often (36.4%), followed by the femur (23.6%). 78.6% of femoral fractures were distal. The mean age of patients with femoral fractures was 9.1 months, and with tibial fractures 29.2 months. Thoracic trauma was diagnosed in 33.6% of cats. Pneumothorax was diagnosed in 20% of cats, and pulmonary contusions in 13.4%. Falls from the seventh or higher stories, are associated with more severe injuries and with a higher incidence of thoracic trauma.

Accidental Falls↗

PubMed2006

Diaphragmatic injuries in children after blunt abdominal trauma.

BACKGROUND: Traumatic rupture of the diaphragm resulting from blunt abdominal trauma remains a challenging clinical entity. Description of such type of injuries in children is scarce in the literature. PURPOSE: The aim of this study was to present this special form of injury in the pediatric age group and compare the different aspects of diaphragmatic injury with that occurring in adults. PATIENTS AND METHODS: Ten cases of diaphragmatic rupture after blunt trauma in children were reported. The presentations, findings, and management were described. RESULTS: This study included 7 boys and 3 girls aged 3 to 16 years. Trauma in 8 cases resulted from motor vehicle or auto-pedestrian accidents and 2 from falling from a height. Chest radiograph shows suggestive signs of diaphragmatic injuries in 7 occasions including intrathoracic visceral herniation in 4 cases and hemothorax in 3 cases. Associated injuries were found in 5 cases in the form of rib fractures in 3 cases and lung contusion in 2 cases. Lung tear, gut perforation, and liver tear were each reported once. Isolated diaphragmatic injury is reported in 5 cases. Three cases were repaired via thoracotomy or laparo-thoracotomy and 7 cases via midline laparotomy. On exploration, we found diaphragmatic avulsion of the costal origin in 5 cases, 3 left and 2 right contrary to tears, of which 4 were left sided and 1 right sided. Primary repair was conducted in 7 cases and an intercostal muscle flap was used in 3 cases. No mortalities were reported. CONCLUSIONS: This series of diaphragmatic rupture in children reveals the following: (1) Avulsion of the costal origin of the diaphragm is a peculiar type of injury described in children (5 of 10). (2) The intercostal muscle flap is a useful tool to bridge diaphragmatic defects. (3) Isolated diaphragmatic injuries do occur in children more frequently than in adults. (4) As in adults, diaphragmatic rupture prevails in the left side, and purposeful surgical diagnosis and early management determine the effectiveness of treatment.

Abdominal Injuries↗

PubMed2006

Human balance, the evolution of bipedalism and dysequilibrium syndrome.

A new model of the uniqueness, nature and evolution of human bipedality is presented in the context of the etiology of the balance disorder of dysequilibrium syndrome. Human bipedality is biologically novel in several remarkable respects. Humans are (a) obligate, habitual and diverse in their bipedalism, (b) hold their body carriage spinally erect in a multisegmental "antigravity pole", (c) use their forelimbs exclusively for nonlocomotion, (d) support their body weight exclusively by vertical balance and normally never use prehensile holds. Further, human bipedalism is combined with (e) upper body actions that quickly shift the body's center of mass (e.g. tennis serves, piggy-back carrying of children), (f) use transient unstable erect positions (dance, kicking and fighting), (g) body height that makes falls injurious, (h) stiff gait walking, and (i) endurance running. Underlying these novelties, I conjecture, is a species specific human vertical balance faculty. This faculty synchronizes any action with a skeletomuscular adjustment that corrects its potential destabilizing impact upon the projection of the body's center of mass over its foot support. The balance faculty depends upon internal models of the erect vertical body's geometrical relationship (and its deviations) to its support base. Due to the situation that humans are obligate erect terrestrial animals, two frameworks - the body- and gravity-defined frameworks - are in constant alignment in the vertical z-axis. This alignment allows human balance to adapt egocentric body cognitions to detect body deviations from the gravitational vertical. This link between human balance and the processing of geometrical orientation, I propose, accounts for the close link between balance and spatial cognition found in the cerebral cortex. I argue that cortical areas processing the spatial and other cognitions needed to enable vertical balance was an important reason for brain size expansion of Homo erectus. A novel source of evidence for this conjecture is the rare autosomal recessive condition of dysequilibrium syndrome. In dysequilibrium syndrome, individuals fail to learn to walk bipedally (with this not being due to sensory, vestibular nor motor coordination defects). Dysequilibrium syndrome is associated with severe spatial deficits that I conjecture underlie its balance dysfunction. The associated brain defects and gene mutations of dysequilibrium syndrome provide new opportunities to investigate (i) the neurological processes responsible for the human specific balance faculty, and (ii) through gene dating techniques, its evolution.

Animals↗

PubMed1998

Fatalities and injuries in the Kuwaiti construction industry.

This paper presents an analysis of construction accidents in Kuwait along with accident causation and injuries that can be considered serious or fatal, so that corrective measures can be taken to decrease casualties, resulting in a safer construction industry. The paper evaluates the existing injury and cost reporting-investigation system of construction accidents in government agencies and private firms. This research confirms that construction is the most hazardous industry in Kuwait, with accidents accounting for 48%, 38% and 34% of all disabling injuries and 62%, 38% and 42% of all fatalities in 1994, 1995 and 1996, respectively. These rates are considered high and can be compared to construction accident statistics in the U.S.A. which accounted for 14% of all work-related deaths and 9% of disabling injuries in 1993. Based on the study, falling from a height appears to be the major cause of construction injuries and fatalities in Kuwait. Poor accident records and reporting systems hide the extent of the construction safety problem in Kuwait. In addition, many people at management level are unaware of accident-related costs and the effectiveness of a safety program in reducing project costs.

Accidents, Occupational↗

PubMed1998

Occupational deaths and injuries in the construction industry.

This study concerned with the characteristics of occupational deaths and injuries in the construction industry of South Korea. The national statistics of industrial accidents in the years 1991-1994 were extracted from the annual publications of the Ministry of Labor. These data were analyzed in terms of the size of company, age of injured person, work experience, accident type, injury type, injured part of body, and agency of accident. The results show that there are some patterns in the characteristics of occupational injuries of construction industry: (1) deaths occur more frequently in the older workers; (2) the most common type of accident is 'falls from a height'; (3) 'fracture' is the leading injury type; (4) the body sites most vulnerable to injury are the leg, foot and toe in the non-fatal injuries, while the head, face, and neck in deaths; (5) most of the accidents occurred from the temporary construction or fabric. The results also show that there are differences in accident characteristics between occupational deaths and nonfatal injuries. These findings identified in this study can be used to decide the accident prevention programs.

Accidents, Occupational↗

PubMed1997

Pulsed magnetic and electromagnetic fields in experimental achilles tendonitis in the rat: a prospective randomized study.

OBJECTIVE: To investigate the effects of pulsed magnetic fields (PMF) and pulsed electromagnetic fields (PEMF) on healing in experimental Achilles tendon inflammation in the rat. DESIGN: Prospective randomized trial. SETTING: University medical school. METHODS: Exposure of the Achilles tendon and injury by a weight of 98.24 g falling from a height of 35cm in 180 male Sprague-Dawley rats. INTERVENTION: A daily 15-minute session with PMF of 17Hz or 50Hz, or PEMF of 15Hz or 46Hz, or a sham session. OUTCOME MEASURES: Random sacrifice 2 hours after the operation, and at 1, 3, 7, 14, or 28 days. Assessment of water content, weight, and histological appearance of the tendons. RESULTS: The time from injury and the various treatment modalities exerted a significant influence on the water content of the tendon after the injury (two-way ANOVA, p = .02). At day 3, the water content of the PEMF 46Hz group was significantly higher than in the other groups, decreasing sharply by day 7, and being similar to the other groups thereafter. By the end of the experiment, the PEMF 15Hz group was not significantly different from the control group. At day 7, the PMF 50Hz group showed significantly lower water content than the control group (p = .03), but at 14 days the PMF 50Hz group was not significantly different from the control group. PMF 50Hz suppressed the extravascular edema during early inflammation. PMF 17Hz showed a similar initial trend, producing a consistent lower water content throughout the experiment, reaching statistical significance by the end of treatment. By the end of the experiment, the collagen fibers had nearly regained their normal alignment in all groups, with a more physiological alignment seen in the PEMF 17Hz group. CONCLUSIONS: The tendon returned to histological normality in all groups, but the PMF 17Hz group showed better collagen alignment by the end of the study. PMF 17Hz resulted in a greater reduction of inflammation, with a better return of the tendon to histological normality. Different PMF and PEMF could be applied according to when treatment is started after the injury. If there is no delay between injury and beginning of pulsed magnetic treatment, PMF 17 should be used.

Achilles Tendon↗

PubMed2001

Closed reduction of the traumatically dislocated hip: a new technique.

Traumatic dislocation of the hip joint without associated fracture is not common. It is the result of high energy transfer usually a RTA or fall from a height. It is a true emergency, and the joint should be relocated within 6h. Failure to do so increases the risk of avascular necrosis of the femoral head with resultant early degenerative joint disease often in an otherwise fit young patient.

Accidents, Traffic↗

PubMed1999

A fabric-dependent fracture criterion for bone.

A fracture criterion for bone tissue is proposed. Bone material is considered to be anisotropic and its properties are described by invoking the concept of directional variation of porosity. The fracture criterion is expressed as a scalar-valued function of the stress tensor and it incorporates an orientation-dependent distribution of compressive/tensile strength. The proposed mathematical framework is applied to a numerical analysis of fracture in the proximal femur due to a fall from standing height. The risk of fracture is assessed in the context of two different porosity distributions, simulating a healthy and an osteoporotic bone.

Anisotropy↗

PubMed1995

Blunt trauma: the pathophysiology of hemodynamic injury leading to erectile dysfunction.

A 9 1/2-year pharmaco-cavernosometry/pharmaco-cavernosography and pharmaco-arteriography study was performed in 131 men with persistent changes in erectile function following blunt pelvic or perineal trauma. The goal was to determine the incidence of hemodynamic impairment, and to characterize the location and pattern of abnormal venous drainage. Corporeal veno-occlusive dysfunction was identified in 62% of the cases and cavernous artery insufficiency in 70%. Pharmaco-cavernosography revealed abnormal venous drainage confined to the proximal corpora in 91% of the cases. Patients with pelvic trauma had significantly more abnormal sites of venous drainage (3 or more sites in 61%) and more severe degrees to which venous structures filled with contrast medium (23% had 3+ degree of luminal filling) than did patients with perineal trauma (61% had 1 or 2 sites of venous drainage and 92% had 1+ or 2+ degree of luminal filling). Pharmaco-arteriography revealed site specific arterial occlusive lesions consistent with the site of impact. Traumatic vasculogenic impotence is hypothesized as being the result of direct impact injury to the fixed proximal corpora and its arterial inflow bed. The exerted perineal impact force is estimated to range from 50 to 500 pounds, depending on the weight of the individual, height of the fall, speed at contact and surface hardness. Traumatic veno-occlusive dysfunction is theorized to be the consequence of focal intracavernous wound repair and permanent focal alterations in erectile tissue compliance. Traumatic vasculogenic impotence afflicts an estimated 600,000 American men of whom 250,000 have sports-related injuries. Future consideration should be given to the development of appropriate protective perineal equipment.

Accidents↗

PubMed1991

Visual modulation of vestibularly-triggered air-righting in rats involves the superior colliculus.

Vision plays two roles in air-righting, it can trigger air-righting in the absence of the labyrinths, and it can modulate the onset and speed of air-righting depending upon the height of the fall. While the visual cortex is known to be necessary for visual triggering, the neural systems necessary for visual modulation are unclear. In this study, the role of the visual cortex and the superior colliculus in visual modulation by rats was analysed. Rats can visually modulate vestibularly-triggered righting, but not trigger righting visually in the absence of the labyrinths. Adult rats with complete neonatal decortication, and adult rats with more specific ablation of the visual cortex were able to visually modulate air-righting. Ablation of the superior colliculi as well as the visual cortex, or ablation of the superior colliculi alone, resulted in loss of the ability to visually modulate air-righting. It is concluded that the superior colliculus is necessary for visual modulation in rats. It is hypothesized that in cats also, the superior colliculus, not the visual cortex, is necessary for visual modulation.

Animals↗

PubMed1998

Human immunodeficiency virus among trauma patients in New York City.

STUDY OBJECTIVE: To determine the HIV seroprevalence rates in relation to the demographic characteristics of victims, cause of death, and toxicology findings in a sample of victims of violence and accidents who presented to emergency departments before death. METHODS: This descriptive survey of a complete 3-year sample of homicides and accidents was conducted in 5 boroughs of New York City (population 7,322,564). Persons 15 years of age and older injured by intentional violence or accidents (excluding drug overdoses, falls from short heights, and suicides) who presented to hospitals, died, and were sent to the medical examiner were included. Standard methods were used to test plasma and serum samples for HIV and cocaine or its metabolite. Chi2 Tests compared HIV seroprevalence across groups according to demographic characteristics and toxicology findings. Logistic regression analysis was done for those variables found to be significant with chi2 tests. All statistical tests were conducted with 2-tailed alpha levels of .05. RESULTS: Among the 1,242 subjects in the sample, 90 (7.2%) had positive findings. Male patients (8%) had higher rates than female patients (3.4%). HIV rates were highest among patients 35 to 44 years of age (20.8%), followed by the 45- to 54-year age group (9.6%) and 25- to 34-year age group (8.1%). Victims of homicide (8.2%) and accidents other than motor vehicle crashes (10.5%) had higher rates than victims of motor vehicle crashes (4%). Patients with positive results for cocaine (16.3%) were more likely than those with negative result (5.8%) to be HIV positive. There were no statistically significant differences by race, except that no Asians were HIV positive. Logistic regression analysis found that only age and positive cocaine results, not sex and race, were related to increased risk of HIV infection. CONCLUSION: We found the rate of HIV infection among victims of fatal trauma was significant, especially in those with evidence of cocaine use. The HIV infection rate approximates the high end of the range of HIV rates found in studies before 1990. It further emphasizes the need for use of universal precautions in the care of trauma patients.

Accidents↗

PubMed2003

Complex suicides by self-incineration.

Among the few cases of suicidal self-incineration primary or secondary complex suicides are a rarity. Accordingly the number of reports on this subject in the forensic literature is small. In a retrospective analysis of the Freiburg and Berlin autopsy material, four cases were found within an observation period of 11 years. These are described together with seven other cases reported in the literature. Altogether most of these suicides are primary combinations, especially with falls from a height. Other combinations include hanging or the infliction of stabs, cuts or gunshot injuries. The sex and age distribution is similar to that found for suicide by self-incineration alone.

Adolescent↗

PubMed1999

Modified Caspari technique for traumatic anterior shoulder instability: comparison of absorbable sutures versus absorbable plus nonabsorbable sutures.

The efficacy of the Caspari technique using a combination of absorbable and nonabsorbable sutures was compared with that of using only absorbable sutures. Forty-four patients (45 shoulders) underwent our modified Caspari technique for traumatic anterior shoulder instability and were followed-up for 2 to 3 years postoperatively. The average age at operation was 22 years. Among 27 patients treated using all absorbable PDS sutures, 7 patients had recurrent instability (success rate, 74%). Among 18 patients treated using both PDS and nonabsorbable polypropylene sutures, only one showed apprehension after a direct blow to the shoulder sustained by falling from a height (success rate, 94%). The mean stability score according to Rowe's criteria was significantly higher in the combination of absorbable and nonabsorbable group (P = .0412). External rotation increased more slowly in the combination of absorbable and nonabsorbable group than in the absorbable group. The mean limitation of external rotation was 8.4 degrees and 2.7 degrees, respectively (P = .0129). The modified Caspari technique using both absorbable and nonabsorbable sutures achieved excellent stability according to Rowe's criteria and external rotation showed more gradual improvement compared to repair with absorbable sutures alone.

Absorbable Implants↗

PubMed1990

Maxillofacial fractures related to work accidents.

Work-related maxillofacial fractures were studied retrospectively over a six-year period. There were 98 cases accounting for 4.5% of all facial bone fractures treated in our hospital between 1981 and 1986. Of the patients, 89.8% were male. The mean age of the injured was 36.4 years. The incidence of work-related maxillofacial fractures was 0.37 per 1000 workers. Most of the injuries (66%) occurred in factories and construction work. Such work was associated with an to 15 times higher risk of maxillofacial fracture than service and office work. Of the fractures, 20.4% were sustained on the way to or coming from work. At the place of work, the commonest causes of injury were blows from objects or falls from a height (70%). On the way to or coming from work, the aetiological factor was most often a traffic accident. Assault and battery had caused facial bone fractures in 11.2% of cases. Fifty-five patients with midface and 45 patients with mandibular fractures were found, of these, 8 patients had bimaxillary fractures. In 6 cases, only dentoalveolar fractures were found. Of the patients, 55.1% were treated operatively. Sixty-six patients were hospitalized, the mean length of hospital stay being 3.2 days (range 1-12 days).

Accidents, Occupational↗

PubMed2000

Decapitation in suicidal hanging--a case report with a review of the literature.

We report a case of self-decapitation by suicidal hanging from a river bridge and discuss the decapitation mechanism, reviewing the literature. The torso and the head of the victim, respectively, were found apart in a river approximately 100 m and 600 m, respectively, downstream from the bridge in two days. Morphological, serological and DNA analyses confirmed their identity. Torn ligaments between the atlas and axis accompanied by fractures in the axis at the partes interarticulares were indicative of a traction force combined with anteroflexion of the head by falling from a height, and the radial pressure due to a strong, single twisted nylon rope with a slip knot was considered to have contributed considerably to the subsequent skin laceration with wavy marginal abrasions. In the reviewed literature, cervical spine fractures were described only in two of six cases, suggesting head movement at the time of decapitation.

Journal Article↗

PubMed1997

Human body model response to mechanical impulse.

Despite our understanding of the importance of falling, previous studies have ignored the effects of falls from standing height. In this article, lumped parameter linear and nonlinear models of a standing human have been used to simulate the impact response of the body segments due to inputs at the shoes. The acceleration transfer and frequency response were determined. The effect of nonlinear damping was simulated. Nonlinear effects were found to be most significant when the input amplitude increases. Frequency response attenuation was significant, resulting in almost a shift in the magnitude plots in the range (0.1-100 Hz) of frequency. When the input amplitude was reduced, the nonlinear effects became apparent only in the medium frequency range. In the case simulating a human subject exposed to impulse at the foot, a large amount of energy is dissipated in the joints due to the friction resulting in a joint disorder. This is most significant at the medium frequency range that is expected to be induced by a running human subject.

Biomechanical Phenomena↗