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PubMed1999

Occupational fatalities in Israel.

Occupational fatal injuries are a worldwide problem. Certain occupations pose a greater risk than others. The purpose of this study was to estimate the death rates from occupational injuries in Israel over a period of 30 months, and to examine the trends in the light of the large numbers of foreign workers who have been brought into the country in the last decade. Two-thirds of the occupational fatalities were in the construction business, mostly owing to falls from a height resulting in death from multiple trauma. About one-third of these victims were foreign workers, even though they comprise only 20% of the work force in this field. Negligible amounts of alcohol were detected in a number of cases. The construction industry is recognized worlwide as a high-risk area claiming many lives each year. The findings in this study suggest that too little attention is given to safety regulations in general, and particularly concerning foreign workers in Israel.

Journal Article↗

PubMed2001

Continuously rising problem of osteoporotic knee fractures in elderly women: nationwide statistics in Finland in 1970-1999 and predictions until the year 2030.

We assessed the current trends in the number and incidence of osteoporotic knee fractures in Finland by collecting data from the National Hospital Discharge Register for all patients > or =60 years of age who were admitted to Finnish hospitals in 1970-1999 for primary treatment of such fractures. The knee fracture was defined "osteoporotic" if it was caused by a low-energy trauma only; that is, a fall from standing height or less. We also predicted fracture development until the year 2030 by a regression model, which took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 persons) of osteoporotic knee fractures in Finnish women aged > or =60 years clearly rose during the study period, from 218 (number) and 55 (incidence) in 1970 to 685 and 113 in 1999. Even after age adjustment, the incidence of women's fractures showed a clear increase, from 59 in 1970 to 105 in 1999. If this trend continues, there will be about 2.5 times more osteoporotic knee fractures in Finnish women in the year 2030 than there were in 1999. In Finnish men aged > or =60 years, the annual number of fractures and its changes were clearly smaller (77 in 1970 vs. 138 in 1999), and the fracture incidence did not show consistent trend changes over time (30 in 1970 vs. 34 in 1999). We conclude that in elderly Finnish women the number of osteoporotic knee fractures shows a rise with a rate that cannot be explained merely by demographic changes and, therefore, vigorous preventive measures are needed to control this development.

Age Distribution↗

PubMed1975

A model for the future care of acute spinal cord injuries.

This is a review of the total care of those acute spinal cord injury patients in Ontario during the years 1969 and 1970, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation. Information was extracted from the available ambulance records, the patients and many of the responsible physicians were interviewed personally. The study was detailed and intensive and included a review of each patient's hospital records in each hospital up to discharge from the rehabilitation programme into the community, or to a chronic care unit. The data was compiled in accordance with a detailed and lengthy questionnaire developed for this study. The incidence of acute cord injuries in Ontario in 1969 and 1970 amounted to 244; in 1969, 15.9 per million population and in 1970, 13.6 per million. As in other studies road accidents took first place, followed by falls from a height; sports injuries ranked third and 65.7% of these were caused by diving into shallow water. Age incidence, and incidence by month, day of week and time of day were identified. Fridays and Saturday afternoons in July and August are particularly hazardous. The study continued to the end of 1974 by which time 34 deaths had been recorded. Peak incidence of death occurred within fourteen days of injury. The most common cause of death was respiratory in origin. Geographical distribution was identified and the type of hospital treating the acutely injured patient. Fourteen percent of persons with spinal column injury suffered progressive or sequential spinal cord damage both prior to and following medical contact. The incidence of pressure sores and genitourinary sepsis and calculosis was high in all types of hospitals. The effect of operative treatment was noted in cases of complete quadriplegia and paraplegia. Of the 133 survivors who undertook a rehabilitation program, 84% returned to their homes and 59% achieved gainful employemnt or ongoing education. The cost was determined of general hospital services and rehabilitation programmes. A new model for the care of the spinal cord injury patients in Ontario was proposed.

Acute Disease↗

PubMed1998

Secular trends in the osteoporotic fractures of the distal humerus in elderly women.

Osteoporosis, with its sequelae of fracture, is a major, continuously increasing threat to the health of the elderly, and therefore reliable epidemiological information is needed for assessment of the fracture development in the future and for effective fracture prevention. However, very little population-based information is available concerning the nationwide numbers, incidences and especially secular trends of osteoporotic fractures other than those occurring at the hip. We determined the current trends in the number and incidence of osteoporotic fractures of the distal humerus in Finnish women in 1970-1995 by collecting from the National Hospital Discharge Register all female patients aged 60 years or more who were admitted to our hospitals in 1970-1972, 1974-1975, 1978-1980, 1983-1985 and 1988-1995 for primary treatment of first osteoporotic fracture of the distal humerus. The fracture was defined as osteoporotic if it occurred on individuals aged 60 years or more as a consequence of a moderate or minimal trauma only (a fall from standing height or less). We also predicted the fracture development till the year 2030 by a regression model, a model that took into account the predicted changes in the fracture incidences and population at risk. The number and incidence (per 100,000 women) of osteoporotic fractures of the distal humerus in Finnish women aged 60 years or more increased from 42 (number) and 11 (incidence) in 1970 to 175 and 30 in 1995. The age-adjusted incidence of osteoporotic fractures of the distal humerus also increased, from 12/100,000 women in 1970 to 28/100,000 women in 1995. If this trend continues, the number of these fractures in Finnish women will be almost three-fold in the year 2030 compared with that in 1995. We conclude that the number of osteoporotic fractures of the distal humerus in elderly Finnish women is increasing more rapidly than can be accounted for by the demographic changes alone and therefore effective preventive measures are imperative to keep this problem in control.

Age Factors↗

PubMed2006

[Treatment of osteoporosis--the new role of the orthopaedic surgeon].

Fractures which are caused by falling from standing height or less are named "fragility fractures". These fractures may indicate neglected osteoporosis and will occur even more frequently in the future, due to the demographic change. This is why osteoporosis will become a challenge to our healthcare systems. For the orthopaedic surgeon treatment of osteoporosis was limited to fracture fixation in the past. As this approach is very focussed towards the fracture as the major complication of osteoporosis, there is a big potential for improvement. It is important to know that such patients suffering from a first fragility fracture are at high risk for being hit by a second or further fragility fractures. A fracture prevention programme should therefore become a mandatory requirement for these patients in the future. The orthopaedic surgeons will be the key players who should put this approach into effect. As we treat most patients with fragility fractures it is our privilege to identify those patients who will most likely benefit from fracture prevention.

Age Factors↗

PubMed2001

Simultaneous bilateral femoral neck fractures: case report.

Bilateral fractures of the femoral neck are rare injuries. We report about the case of a 33-year old male with multiple injuries including fractures of both femoral neck after a fall from great height. The fractures were successfully treated with 130 degrees blade plates, allowing early mobilisation.

Adult↗

PubMed2002

Widespread post-traumatic acute spinal subdural haematoma: case report and review of the literature.

STUDY DESIGN: A case report of acute post-traumatic spinal subdural haematoma (ASSH). OBJECTIVE: To report a rare post-traumatic problem. SETTING: Dicle University Hospital, Diyarbakir, Turkey. METHOD: A 3-year-old boy was admitted to our clinic with paraplegia 24 h after falling from a height of about 5 meters. Investigation revealed an acute spinal subdural haematoma. RESULTS: Following surgery there was marked improvement. The rehabilitation of the patient continues. CONCLUSION: MRI is the most valuable diagnostic method. In each case diagnosed as ASSH, prompt evacuation should be performed before irreversible neurological damage occurs.

Acute Disease↗

PubMed2001

[Carpo-metacarpal dislocation injuries].

Carpometacarpal dislocations are rare. In most cases, the dislocation is caused by a violent injury, e.g. the crash of a motorcyclist or a fall from great height. A considerable swelling of the back of the hand may mask the characteristic lump at the root of the hand. The diagnosis can be easily missed due to serious associated injuries. The lesion is also often overlooked in the routine X-ray diagnostic. Lateral and oblique views are important for the recognition of the true extent of the lesion. Anatomical reposition is difficult if the dislocation is not fresh and open reposition is necessary. Between 1990 and 1999, altogether 16 patients who had suffered a carpometacarpal dislocation were treated. One patient had a rare dislocation of the III. to V. joints. Simultaneous dislocation of all five carpometacarpal joints was seen in three cases. The treatment mostly consists of closed reduction and temporary Kirschner wire transfixation. Fourteen patients were controlled (clinical examination and X-ray control) after an average follow-up time of three years. In addition, the DASH questionnaire was used. After an average time of 3 years the patients showed in 64% of the cases excellent and good results (eight excellent, one good). The subjective function of the hand was moderate in 29% (four patients), in one patient the subjective function was poor (7%). Five patients had a diminished range of motion of the hand. The average points in the DASH questionnaire were 24. We recommend as therapy of choice after primary closed repositioning, primary surgery by means of short Kirschner wires introduced from distal-dorsal to proximal-palmar. In cases of impossible closed reduction or in cases with local additional injuries, open treatment for fixation, is indicated.

Adult↗

PubMed1990

[Fronto-basal fractures in the child].

The particularities and the authors' management of frontobasal fractures in children are discussed on the basis of cases treated at the authors' department during the last five years. Fifteen children aged between four and 16 years (mean eight years) made up 14.5% of all frontobasal fractures. The causes of the injury were equally divided between falls from a height of at least 2 m and traffic accidents. All children except one were treated immediately after the accident. The exception was a child with an accident two and a half years before operation and two episodes of late onset meningitis. The diagnoses were mainly made with the help of high resolution computer-tomographies, which permitted a correct localization of the fractures site. The exact course of the fracture was recognized correctly in seven of eleven cases. Each case was managed in interdisciplinary fashion together with the neurosurgeon and the general surgeon. If nonoperative management was chosen, a computer-tomography about six weeks after the injury had to demonstrate the return to normal appearance of the paranasal sinus. If a dural tear was ascertained, a repair with a rhinosurgical approach was favored and, thereby, a definite closure was obtained in seven out of nine cases. One case was primarily managed by a combined rhino- and neurosurgical approach, while two cases were reoperated neurosurgically because of persistent cerebrospinal fluid leakage after the rhinosurgical repair. No other postoperative complications, such as meningitis or a third operation, were encountered. The authors believe that these favorable results were obtained because of individual management of each case by an interdisciplinary team working closely together.

Adolescent↗

PubMedDate not supplied

[Biomechanical analysis of locomotion patterns of the lower extremity. I. Acceleration].

Starting with his own biostatic analysis of strains and stresses affecting the human hip joint the author here extends his observations to include movement. Since the acceleration rates of individual parts of the body have to be known to calculate internal joint forces, calculations done a realistic three-limbed model are described. The braking process following a free fall from a height of 1.5 m is analyzed as a simple locomotion pattern and the calculated acceleration rates are compared with measurements published in the literature. With the model presented here locomotion patterns can be described very well and quantitatively recorded.

Acceleration↗

PubMed2000

Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium.

We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. The number and incidence (per 10(5) persons) of fractures increased sharply from 208 (number) and 32 (incidence) in 1970 to 1,105 and 110 in 1998. Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.

Aged↗

PubMed1995

Effects of symmetry and load absorption of a falling load on 3D trunk muscular moments.

Some epidemiological data have suggested that many physical causes of low back pain such as bending and twisting were, in fact, sudden maximal efforts incidentally carried out at the moment of accident. Sudden loading conditions may be encountered in several circumstances, one of them being the recuperation of a falling load. Such conditions are more likely to occur in conditions of trunk asymmetry. The objective of this study was to determine spinal loadings associated with the reception of a falling box symmetrically and asymmetrically for two mechanisms of load absorption, one limited to the elbows and the other including full absorption with the elbows and lower limbs. It was hypothesized that asymmetrical receptions would be more strenuous for the spine; it was further hypothesized that the full absorption to decelerate the load might be more efficient in reducing the strain in the trunk muscular moments. Nine students in physical education with limited experience in manual materials handling were the subjects of the study. The tasks consisted of receiving a 6.6 kg load falling from a height of 50 cm above the flexed forearms when in a standing position. The subjects were tested with two AMTI force plates and two Locam cameras coupled with two mirrors; dynamic 3D multi-segment models were constructed and the net muscular moments as well as the angular velocities of the trunk relative to pelvis were determined about the three orthogonal axes of the trunk at L5/S1, in twisting, lateral bending, and flexion/extension. The dependent variables included maximal moments, maximal rates of loading for these moments, and the integration of these moments. Statistical analyses were performed to test the main effects of symmetry and absorption and their interaction. The results showed that asymmetrical conditions impose supplementary muscular exertions for trunk muscles, especially the trunk extensors and lateral flexors. Contrary to the proposed hypothesis, full absorption as used in the present study was a condition leading to considerably larger muscular exertions, especially for the loading rates. Thus it was concluded that the process of training for load absorption is essential to effectively decrease the risks of injuries. This factor would merit full consideration in future studies.

Absorption↗

PubMed2000

The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms.

Patients with a history of closed head trauma and subarachnoid hemorrhage are uncommonly diagnosed with an intracranial saccular aneurysm. This study presents a group of patients in whom a pre-existing aneurysm was discovered during work-up for traumatic subarachnoid hemorrhage. Without an accurate pre-trauma clinical history, it is difficult to define the relationship between trauma and the rupture of a pre-existing intracranial saccular aneurysm. We retrospectively reviewed 130 patients who presented to Detroit Receiving Hospital between 1993 and 1997 with a diagnosis of subarachnoid hemorrhage (SAH). Of these 130 patients, 70 were spontaneous, and 60 had a history of trauma. Mechanisms of trauma include motor vehicle accident, assault, or fall from a height. Of the 60 patients with subarachnoid hemorrhage and a history of trauma, 51 (86%) did not undergo conventional four-vessel angiography, and had no further neurological sequelae. Nine patients (14%) had a suspicious quantity of blood within the basal cisterns or Sylvian fissure and had a four-vessel angiogram. Five patients (8%) were diagnosed with a saccular intracranial aneurysm, and all underwent surgical clipping of the aneurysm. We conclude that the majority of patients (92%), with post-traumatic SAH do not harbor intracranial aneurysms. However, during initial evaluation, a high level of suspicion must be entertained when post-traumatic subarachnoid hemorrhage is encountered in the basal cisterns or Sylvian fissure, as 8% of our population were diagnosed with aneurysms.

Adult↗

PubMed2000

Calcaneus fractures with subluxation of the posterior facet. A surgical indication.

The charts and radiographs of 118 patients with 126 intraarticular fractures of the calcaneus were reviewed retrospectively. Eleven of 126 (8.7%) calcaneal fractures had injuries consisting of intraarticular calcaneal fracture, lateral subluxation or dislocation of the posterior facet, fracture extension into the calcaneocuboid joint, peroneal tendon subluxation, subluxation of the talus in the ankle mortise, and complete disruption of the anterior talofibular and calcaneal fibular ligaments or fracture of the lateral malleolus. There were six women and five men. The average age was 40 years (range, 17-65 years). The mechanism of injury was a motor vehicle accident in eight and a fall from a height in three. According to the classification of Sanders et al eight fractures were Type II, one was Type III, and two were Type IV. Followup at an average of 26 months (range, 14-38 months) showed that eight of 11 patients (72.7%) had either good or excellent results. When lateral subluxation of the posterior facet of the calcaneus is identified with a preoperative computed tomography scan, operative management is indicated, and the surgeon should search for associated injuries that should be addressed at the time of surgery.

Adolescent↗

PubMed1997

Evaluation of the temporal evolution of acute spinal cord injury.

RATIONALE AND OBJECTIVES: After receiving a controlled injury to the thoracic cord, five rats were examined on a 1.5-T magnetic resonance (MR) imaging system at regular intervals over 1 month to assess evolution of the injury. METHODS: After the rats received pentobarbital anesthesia, a T10 laminectomy was performed on them, which exposed the dura over the dorsal surface of the spinal cord. With the animal placed in a New York University weight-drop device, a 10-g rod with a flat brass tip was dropped (free-fall) from a height of 50 mm to impact the cord. After injury, the incision was closed with suture material. Each animal was imaged on the day of injury, and at 7, 14, and 28 days after injury. Before contrast injection was administered, sagittal sections were obtained with T2 fast-spin echo and T1-spin echo technique. Each rat then received 0.3-mmol/kg gadoteridol (Gd HP-DO3A or ProHance) intravenously, with the T1 scan repeated. At 28 days, the animals were killed, and the cord was fixed and embedded in paraffin for histologic evaluation. RESULTS: The intensity of cord enhancement in the region of injury, after intravenous (i.v.) contrast injection, was at a maximum on the day of injury, and it decreased in a steady fashion thereafter. The intensity was 11.7 +/- 0.6 on the day of injury, 9.7 +/- 2.6 on day 7, 6.3 +/- 5.3 on day 14, and 0.0 +/- 2.3 on day 28. The results on day 0 and 7 were statistically significant in terms of a difference from that on day 28, with a P value < 0.001. The length of cord injury, assessed postcontrast, also decreased in a steady fashion from the day of injury. The length of injury (in cm) was 1.1 +/- 0.1 on the day of injury, 0.5 +/- 0.2 on day 7, 0.3 +/- 0.1 on day 14, and 0.1 +/- 0.1 on day 28. The results on day 0 and 14 were statistically significant in terms of a difference from those at the next time point, with P values from < 0.01 to < 0.001. Visually, on T2 images, substantial edema was noted on day 0, with progression to focal cord atrophy and gliosis by day 28. CONCLUSIONS: Acute spinal cord injury in a rat model is well visualized on pre- and postcontrast MR scans at 1.5 T. Observation of T2 changes and disruption of the blood-spinal cord barrier provide markers for temporal assessment of spinal cord injury in the rat model.

Acute Disease↗

PubMed1987

Simultaneous fractures of the distal radius and scaphoid.

Simultaneous fractures of the distal radius and the scaphoid are uncommon. A study of seven male patients who had sustained this fracture combination revealed the most frequent cause of the injury was a fall from a height. The distal radial fracture, usually unstable and intra-articular, was the principle fracture in this complex injury. In contrast, most of the scaphoid fractures were stable. Four of the radial fractures were treated by closed reduction and cast immobilization. In the remaining three, an external fixator was used to maintain the reduction. Four scaphoid fractures were immobilized in a cast, two were internally fixed, and one was left untreated. At an average follow-up period of 20 months (range from 12 to 52 months), all seven patients had regained satisfactory use of their hands. (Three results were classified as excellent and four good.) All scaphoid fractures healed. Transient avascular necrosis was noted in one scaphoid, but cleared within 5 months. Advanced radiocarpal arthritis developed in one wrist, but its presence did not adversely affect the late functional result.

Adolescent↗

PubMed1992

Acute foot compartment syndromes.

Twelve cases of compartment syndrome of the foot in 10 patients were retrospectively reviewed. All were high-energy injuries sustained in a fall from a height (six), crush (three), or motor vehicle accident (three). Bone injuries of the foot included five calcaneal fractures, three multiple metatarsal and/or phalangeal fractures, and two Lisfranc fracture-dislocations with multiple metatarsal neck fractures. The most consistent physical finding was tense swelling of the foot. The diagnosis was confirmed with compartmental pressure measurements in all cases. Decompressive fasciotomies were adequately performed by the medial approach of Henry or a combined approach with medial and dorsal incisions. An additional lateral incision was used in two instances.

Adult↗

PubMed1994

Ankle dislocation.

From 1980 to 1991, 14 patients with pure ankle dislocation unassociated with fracture were identified. All patients were young adults (18-41 years of age) with a male preponderance (11 of 14). The cause of injury in nine of the 14 cases was a motor vehicle accident and in the remainder, sporting events or fall from a height. Thirteen of the 14 injuries were open, and 12 patients underwent lateral ligamentous repair. Twelve of the 14 patients were available for follow-up, which ranged from 15 to 122 months. Two patients had poor results; the remainder (10 of 12) had good and excellent results. Interestingly, no patient had signs or symptoms of instability. One patient required immediate below-the-knee amputation for open dislocation associated with avulsion of soft tissue and neurovascular structures.

Adolescent↗