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PubMed2006

Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004.

OBJECTIVE: Our objective for this study was to describe the epidemiology of lawn mower-related injuries among children in the United States. METHODS: A retrospective analysis was conducted of data from children who were 20 years and younger in the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990-2004. RESULTS: There were an estimated 140700 lawn mower-related injuries to children who were 20 years and younger and treated in hospital emergency departments in the United States during the 15-year period of 1990-2004. This yielded an average of 9400 injuries annually, or 11.1 injuries per 100000 US children per year. The mean age was 10.7 (SD: 6.0) years, and 78% were boys. The leading type of lawn mower-related injury sustained by patients was a laceration (41.2%), followed by soft tissue injury (21.4%), burn (15.5%), and fracture (10.3%). The most common body region injured was the hand/finger (34.6%), followed by lower extremity (18.9%) and foot/toe (17.7%). The eyeball/face and upper extremity accounted for 10.6% and 7.4% of injuries, respectively. Burns accounted for 34.5% of injuries to the hand/finger compared with 5.5% to other body regions. Ninety-seven percent of amputation injuries occurred to the foot/toe (49.5%) and hand/finger (47.5%) compared with 3% of amputations to other body regions. Burns accounted for 41.8% of injuries among children who were < or = 5 years of age compared with 6.5% of injuries to children who were older than 5 years. Foreign body injuries accounted for 4.8% of injuries among children who were > or = 12 years of age compared with 1.6% of injuries to children who were younger than 12 years. Amputations (31.9%), lacerations (28.8%), and fractures (26.0%) accounted for almost 87% of injuries among children who were admitted or transferred to another hospital. In contrast, lacerations (42.3%), soft tissue injuries (23.3%), and burns (16.9%) predominated among children who were treated and released to home from the emergency department. Children with amputations were more likely to be admitted than children with other types of injury. CONCLUSIONS: Injuries related to lawn mowers are an important cause of pediatric morbidity. The relative consistency of the number of lawn mower-related injuries to children during the 15-year study period is evidence that current prevention strategies are inadequate. Passive protection that is provided by safer product design is the strategy with the highest likelihood of success in preventing these ongoing injuries. The lawn mower voluntary safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all ride-on lawn mowers with a no-mow-in-reverse default feature with location of its override switch behind the seating position of the ride-on mower operator. By locating the no-mow-in-reverse override switch behind the ride-on mower operator, the operator would be required to look behind the mower before mowing in reverse.

Accidents, Home↗

PubMed1999

Fractures of the elbow.

Elbow fractures encompass a spectrum of severity from low energy nondisplaced fractures to high energy fractures with associated severe soft-tissue injury. Treatment is based on fracture pattern, patient age, bone quality, associated soft-tissue injuries, and associated fractures. The basis for treatment relies on the knowledge of the complex osseous and soft-tissue anatomy of the elbow. The goals of operative and nonoperative treatment are to achieve a stable, anatomic reduction that allows early motion to maximize function.

Fracture Fixation, Internal↗

PubMed1989

Back injuries to fast bowlers in cricket: a prospective study.

Eighty-two high performance young male fast bowlers (mean age 16.8 years) were tested immediately prior to the season for selected kinanthropometric and physiological data. Subjects were also filmed both laterally (200 Hz) and from above (100 Hz) while bowling so that their front foot impacted a force platform during the delivery stride. The players then completed a log book over the ensuing season that detailed their training and playing programmes. All cricket related injuries over this season were assessed by a sports physician who used computerized tomography to assist in the diagnosis of spinal injuries. At the completion of this season the players were grouped according to their injury status (Group 1--bony injury to a vertebra; Group 2--soft tissue injury to the back that caused the player to miss at least one game, and Group 3--no injuries). A one-way analysis of variance was used to identify if any variables were significantly (P less than 0.05) different between the three groups, and a Scheffe post hoc comparison was used to determine which groups were significantly different. Eleven per cent of the players sustained a stress fracture to a vertebra(e) (L4 to S1), while 27 per cent sustained a soft tissue injury to the back. Bowlers with a low longitudinal foot arch were more likely to develop a stress fracture than those with a high arch. Shoulder depression and horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb were also significantly related to back injuries. Results suggest that bowlers with the above physical characteristics, who bowl with these biomechanical techniques for extended periods, are predisposed to back injuries.

Adolescent↗

PubMed1998

The epidemiology of humeral shaft fractures.

We have analysed 249 consecutive fractures of the humeral shaft treated over a three-year period. The fractures were defined by their AO morphology, position, the age and gender of the patient and the mechanism of injury. Open fractures were classified using the Gustilo system and soft-tissue injury, and closed fractures using the Tscherne system. The fractures were classified as AO type A in 63.3%, type B in 26.2% and type C in 10.4%. Most (60%) occurred in the middle third of the diaphysis with 30% in the proximal and 10% in the distal third. The severity of the fracture and soft-tissue injury was greater with increasing injury severity. Less than 10% of the fractures were open. There was a bimodal age distribution with a peak in the third decade as a result of moderate to severe injury in men and a larger peak in the seventh decade after a simple fall in women.

Accidental Falls↗

PubMed2003

Neck injuries among the elderly in Sweden.

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patients.

Accidental Falls↗

PubMed1959

Injuries of the hand and forearm; treatment of damaged soft tissues.

Successful primary repair of soft tissue injuries of the hand and forearm holds the ultimate disability to a minimum. The kinds of trauma and the resultant soft tissue damage may be classified. Attention to details and technique in carrying out the primary reparative operation on the injured hand largely obviates a crippling deformity or the need for much reconstruction later.

Forearm↗

PubMed1995

Primary reamed intramedullary nailing of open femoral shaft fractures.

Forty-two patients with acute open femoral shaft fractures were assigned prospectively to primary immediate or delayed reamed intramedullary stabilization. There were 27 primary and 15 delayed intramedullary nailings performed (mean followup, 20 months). Twelve patients (29%) had Gustilo and Anderson Grade I injury; 16 (38%), Grade II; and 14 (33%), Grade III (including 3 Grade IIIC). Average time to union was 3.8 months. The infection and nonunion rate was 2.4%. Comparison of the 2 groups showed no significant differences in the incidence of infection, malunion, nonunion, or the time to union. The data suggest that primary reamed intramedullary nailing is an effective treatment alternative for the patient with multiple injuries, regardless of soft tissue injury, including Grade III wounds. Isolated open femoral shaft fractures with Grade I and Grade II soft tissue wounds may be stabilized safely primarily with no increased morbidity. Although results were promising, continued study is needed to delineate the optimum management of all Grade III injuries.

Adolescent↗

PubMed2006

Incidence of sports injuries in elite competitive and recreational windsurfers.

OBJECTIVE: To investigate the incidence of injury in windsurfing and to consider methods of prevention. METHODS: A total of 107 raceboard (RB) and wave/slalom (WS) national/international competitors and recreational (REC) windsurfers completed a questionnaire on injury incidence over two years. Recurrent injury, ability level, and any preventive measures taken were noted. RESULTS: Overall the injury incidence was 1.5/person/year. The WS group suffered more injuries (2.0/person/year) than the RB (1.0) or REC (1.2) group. The most common injury was muscle strain at 35% of new injuries, much higher than in earlier studies. Overall 45% of new injuries were muscle/tendon strains (RB 55%, WS 42%, and REC 43%) and 8% were ligament sprains. In the WS group cuts and abrasions were common. The WS and REC groups reported five and one case of concussion respectively. Nearly a quarter (22%) of new lower body injuries were lower back muscular strain, with 34% of recurrent injuries. Approximately 60% of the remaining lower body soft tissue injuries involved the knee or lower leg, with the ankle/foot most often involved. The shoulder, upper arm, and elbow were the sites of 41% of new upper body soft tissue injuries. The WS group reported 250% more recurrent muscular strains than the RB group. Recurrent ligament injuries (particularly knee) were most common in the WS group. The RB group reported recurrent serious bruising to the lower leg. CONCLUSION: The injury incidence was 1.5/person/year with a high incidence of new and recurrent muscular strain. Lower back muscular strain was prevalent, indicating the need for preventive measures. Wave/slalom was associated with more new and recurrent injuries and the need for head protection.

Adolescent↗

PubMed1999

[Falls incurred by the elderly resulting in injury: pathogenesis and rehabilitation].

Falls prove to be a significant problem in geriatrics. 5% of falls lead to fractures and 10% to soft tissue injuries. We examined retrospectively the rehabilitation course of 78 patients, who had been treated by us after falls leading to injury. Fractures of the neck of femur predominated with 57%, followed by other fractures of the lower limbs with 13%. The remainder of the falls with consequences of injury lead to fractures of other parts and soft tissue injuries. In 34% of the falls, the cause was estimated as predominantly intrinsic and in 11% as extrinsic. 19% of the falls were a mixture of extrinsic and intrinsic factors. In 36% of the cases the cause remained unknown. Before the fall occurred, 72% were independent, 26% needed help and 1 patients was in need of care. After finishing rehabilitation 54% were independent, 34% needed help and 11% were in need of care. 86% were able to return to their usual social surroundings. Rehabilitation after falls with consequences of injury goes beyond mere "orthopedic" treatment. To minimize the future risk of fall, a precise analysis of the cause of fall should be implemented. One should moreover try to optimize the environment to reduce the risk.

Accidental Falls↗

PubMed2002

Infection control: avoiding the inevitable.

Infection, while a major cause of morbidity, should not be considered an inevitable consequence of injury. Good aseptic technique, compulsive attention to detail, and thorough understanding of the points addressed in the following list of critical points are the best guarantee that infection will not add avoidable morbidity to misfortune. Critical points regarding infectious problems in care of the injured child: 1. Polymicrobial infection is the rule with 50% of isolates being mixed aerobic and anaerobic bacteria. 2. It is a misnomer to consider antibiotic use in a pediatric trauma victim as prophylactic. Antimicrobials used in this setting are best considered adjunctive. 3. The major indication for anti-infective therapy in pediatric trauma is an injury with a high probability of infection. 4. Antibiotics do not sterilize the wound or body cavity; they limit bacterial proliferation, thereby supplementing effective immune control. 5. Available studies suggest that 24 hours is as efficacious as a longer treatment duration in a purely adjunctive mode. 6. In bites inflicted by dogs and cats, Pasturella species are frequent. 7. Human bites may result in infection by Eikenella corrodens. 8. Based on this bacteriology, adjunctive intravenous ampicillin sulbactam or oral amoxicillin clavulanate are recommended for human and animal bites. 9. Tetanus prophylaxis is indicated in all significant soft tissue injuries. 10. Risk of osteomyelitis correlates directly with the extent of the associated soft tissue injury and vascular compromise. 11. The majority of infectious complications in the injured child are not a consequence of the injury itself, but rather in the treatment thereof. 12. In the injured child the most common nosocomial infection is lower respiratory followed by primary blood stream and the urinary tract. 13. The management of nosocomial pneumonia in the injured child is based on the time of diagnoses. Early evidence of pulmonary infection requires treatment with a third generation cephalosporin with or without an antistaphylococcal penicillin. Late pneumonia is treated with an aminoglycoside with or without an antipseudomonal added. 14. Catheter related infection is, in the injured child, overwhelmingly gram positive with coagulase negative staphlococcal species accounting for 30-60% of isolates. Staphlococcus aureus is responsible for an additional 15-20%. 15. The role of antibiotics in the prevention of catheter related meningitis is controversial. Recent adult studies suggest no advantage to their routine use. If utilized, they should only be employed prophylactically and not continued throughout the monitoring period. 16. Lack of response to treatment of sepsis may represent an inappropriate antimicrobial agent, improper dosage, inability to achieve adequate levels at the site of infection. (eg, CSF) fungal pathogen, and/or ongoing contamination or undrained purulent focus.

Antibiotic Prophylaxis↗

PubMed2001

Aneurysm of the internal carotid artery following soft tissue penetration injury.

Aneurysms of the extracranial arteries are in most cases secondary to atherosclerosis but may also be due to degeneration, congenital abnormalities, trauma or unclear etiology. They present either with bulging in the lateral pharyngeal wall or the neck. Therefore, otolaryngologists are often among the first physicians to see the patient. In this report, we present a case of spontaneous oral bleeding that was caused by a pseudoaneurysm following 2 weeks after a soft tissue penetration injury in a child. The facial swelling of the child was initially diagnosed to be mumps by its pediatrician and the fever treated with aspirin. A pseudonaneurysm of the internal carotid artery was identified by arteriography as the source of the abrupt oral bleeding and required immediate surgical treatment including radiological means. Our report should illustrate the importance of careful preoperative evaluation as well as a high index of suspicion especially in children, where evaluation of history is difficult.

Accidental Falls↗

PubMed1986

[Isolated soft tissue trauma and combination injuries].

The special problem in severe soft tissue injuries of the lower limb are the thin soft tissue coverage and the diminished blood supply of the distal lower limb and foot. For this reason there is a big difficulty in estimating the severity of the injury. We developed a classification for severe lower limb and foot injuries and classified: soft tissue damage. concomitant local injuries. fracture type. classification of multiple injuries. time of treatment. This classification resulted in 4 groups, which have a prognostic value especially towards amputation or preservation of the limb.

Fractures, Bone↗

PubMed2004

Epidemiology study of facial injuries during a 13 month of trauma registry in Tehran.

BACKGROUND: Many studies have recently noted a shift in the causative mechanism of facial injuries away from traffic accident to assaults. AIMS: Our study aimed to investigate patterns of facial injuries in trauma patients during 13 months study of trauma patients in six general hospitals in Tehran. MATERIAL AND METHODS: Trauma patients who were hospitalized for more than 24 hours and had sustained injuries within seven days from admission were included in the study. Of the 8000 trauma patients, four hundred (5%) sustained facial injuries. RESULTS: Male to female ratio was 4.5:1. Among them, 53.3% were aged 11-30 years. Traffic accidents were by the far the commonest cause of injury. Motorcyclists who wore a helmet sustained facial fractures less often during traffic accident than those patients who did not wear helmet. Soft tissue injury and facial bone fracture comprised 43.3% and 40.8% of facial injuries, respectively. The majority of Soft tissue injuries (79%) were located extra orally. The mandible and nasal bone were the most commonly fractured facial bones. Victims of assault sustained more severe injuries compared to those involved in falls and traffic accidents. CONCLUSIONS: Use of helmets by motorcyclists and the separation of pedestrians routes from motor vehicles could reduce the number of victims and consequently injuries due to road traffic accidents. For implementation of effective prevention programs for reduction of facial injuries due to assault, it seems to be necessary to conduct studies investigating causes and pattern of injuries resulting in assault.

Adolescent↗

PubMed1982

Injury to popliteal vessels.

Between 1969 and 1981, 61 patients with 85 popliteal vascular injuries were seen. In the nine patients who required amputation, common risk factors included (1) extensive time delays (greater than 36 hours) between injury and repair, (2) associated bone and soft-tissue injuries leading to postoperative wound infection. amd (3) early occlusion of popliteal artery repair or delay in performance of fasciotomy. The low amputation rate in patients without operative delay or associated bone and soft-tissue injuries (2/54 = 3.7%) was attributed to the careful application of standard vascular surgery techniques in combination with early use of leg fasciotomy when indicated. Polytetrafluoroethylene grafts as substitute vascular conduits in the popliteal artery have an excellent patency rate and seem to be an acceptable prosthesis when segmental resection of the artery is necessary.

Adult↗

PubMed1997

Nuchal fibrocartilaginous pseudotumor: a distinctive soft-tissue lesion associated with prior neck injury.

Soft-tissue tumors with a predilection to involve the head and neck region include spindle cell lipoma, pleomorphic lipoma, and nuchal fibroma. We have recently studied three patients with distinctive soft-tissue fibrocartilaginous masses in the posterior aspect of the base of the neck, at the junction of the nuchal ligament and the deep cervical fascia. Two of the patients were women (ages 37 and 40) and one a man (age 53). All three had sustained neck injuries in automobile accidents in the past (27 years, 20 years, and 2 months before surgery, respectively). Each patient presented with a soft-tissue nodule overlying the spinous process of one of the lower cervical vertebrae. Two were painful. Computed tomography and magnetic resonance imaging performed in two patients showed focal thickening of the ligamentum nuchae at the C4-5 and C5-6 levels. All three masses were completely excised. They ranged in size from 1.0 to 1.5 cm. The three lesions were histologically identical, and each consisted of a poorly defined, moderately cellular fibrocartilage nodule located within the nuchal ligament at its junction with the deep cervical fascia. Atypia or mitotic activity was not present. The ligamentous tissue adjacent to the mass was irregular and degenerated. None of the masses have recurred in follow-up periods of 3 to 6 months, and all patients are currently asymptomatic. The lesion we describe is a distinctive soft-tissue pseudotumor that occurs in the mid-line of the lower cervical spine within the nuchal ligament. It is likely non-neoplastic and probably develops as a reaction to soft-tissue injury, in an analogous manner to fibrocartilage metaplasia seen in degenerated tendoligamentous structures. We propose the term "nuchal fibrocartilaginous pseudotumor" for these lesions.

Adult↗

PubMed1998

Local or free muscle flaps and unreamed interlocked nails for open tibial fractures.

The treatment of open tibial fractures associated with severe soft tissue injuries remains a difficult dilemma, even to the experienced fracture surgeon. To ascertain the efficacy of nailing tibial fractures with severe soft tissue injuries, a review of all open tibial fractures treated at the authors' institution was done. Those fractures initially stabilized with nonreamed nails which required muscle flaps for coverage were selected for study. Thirty-three patients (26 men, seven women) were treated with intramedullary nailing and muscle flap coverage for the soft tissue defects. The average length of followup was 12.1 months (range, 7-42 months). The average time to union was 27 weeks (range, 14-45 weeks). There were five (15%) infections: two (6%) superficial wound infections, one (3%) flap infection, and two (6%) cases of osteomyelitis. In no patient did the infection result in limb ablation. Thirteen of 33 (42%) patients required secondary procedures to enhance union. In this study, it was found that although delayed procedures frequently were required to promote fracture union, the time to union, and infection rates were not significantly different from those reported for external fixation of fractures that require local or free muscle transfers.

Adolescent↗

PubMed2002

Head and neck injuries in fatal motorcycle collisions as determined by detailed autopsy.

Detailed layer-by-layer autopsy of the head and neck was performed on a series of seventy-three fatally injured motorcyclists in order to identify occult soft tissue injuries such as subluxation of the cervical spine or hemorrhage of vertebral or internal carotid arteries. The fatal cases were gathered as part of a larger study of 1082 on-scene in-depth motorcycle crash investigations in Thailand. Injuries were coded using the 1990 Abbreviated Injury Scale (AIS 90) and an Injury Severity Score (ISS) was determined for each case. Twenty-eight motorcyclists had been wearing a helmet at the start of the collision sequence, but only nine helmets remained in place through the entire collision event. Both helmeted and unhelmeted motorcyclists showed a high frequency of neck injuries such as hemorrhages in the carotid sheath compressing the vagus nerve, hemorrhages surrounding the phrenic nerves or the brachial plexus, or hemorrhages surrounding the vertebral arteries. The most significant finding of this study was the identification of serious internal neck injuries even when there was no external physical evidence of trauma to the neck. Virtually all riders with significant head injuries showed some of these soft tissue neck injuries. This may be important for trauma physicians, who are presented with critically injured motorcyclists with complex multiple trauma, which may include occult soft tissue neck injuries.

Abbreviated Injury Scale↗

PubMed1989

Soft tissue cervical spinal injuries in motor vehicle accidents.

Soft tissue cervical spinal injuries occurred in 179 out of 1197 consecutive victims of road traffic accidents who needed to attend hospital; an incidence of 15 per cent. It was most common in female (P less than 0.01), restrained car occupants (P less than 0.05) in the 40-49 years age group (P less than 0.025). It was less common in rear seat passengers (P less than 0.001). Most were victims of collisions from the rear but significant numbers also occurred in other types of accidents. The incidence of associated injuries was low.

Accidents, Traffic↗