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At least 631 records · Page 35Linked to original sources
PubMed1989

Pylon fractures of the distal tibia.

Forty-two patients with pylon fractures were categorized into Rüedi and Allgöwer Type I (26%), Type II (29%), and Type III (45%) subgroups and assessed. The mean follow-up period was 4.4 years (range, two to eight years). Type I fractures were usually torsion injuries, whereas Types II and III fractures were associated with violence (i.e., motor vehicle accident or fall from a height). Types I and II pylon fractures proved to be amenable to open reduction and restoration of anatomic position, stable internal fixation, early joint motion, and delayed weight bearing. Over 80% of these patients had satisfactory function. Nonanatomic reduction, unstable fixation, infection, nonunion, malunion, and secondary arthrosis were associated with disability from Type III pylon fracture treatment. Only 32% of Type III pylon fracture patients had satisfactory joint function.

Adult↗
PubMed1989

[A retrospective clinical study of the fractures and luxations of the mandible in the cat].

Twenty-six cases of mandibular fractures and luxations are reviewed. Mandibular trauma was due to car accidents (46%) and falls from great heights (23%). Cardiovascular shocks (40%), thoracic injuries (23%), epistaxis (30%), cleft palates (19%), subconjunctival hemorrhages (15%), broken canines (15%), concussions (15%), maxillary fractures (12%) were the most frequently encountered associated problems. Of the 26 cats, 22 had symphyseal fractures, 6 mandibular body fractures, 4 ramus fractures (3 of which were articular) and 6 had temporo-mandibular luxations. Open reduction and internal fixation was performed in 21 cases, surgery being indicated for unstable symphyseal and body fractures, the rostral body fractures being the most challenging to repair. Conservative therapy and ancillary treatment methods such as external coaptation and pharyngostomy were used for the fractures of the ramus. Six temporo-mandibular luxations associated with mandibular fractures in 5 cases were reduced under anesthesia. Good dental occlusion and mandibular function was obtained in the 24 treated cases.

Animals↗
PubMed1983

[Traumatic rupture of the diaphragm. 67 cases].

As a result of improvements in accident prevention, traumatic rupture of the diaphragm is less commonly observed. Young adults are anatomically more exposed to the injury. Beside the classical factors, falls from great heights and direct traumas must be borne in mind as possible causes. Tears in the diaphragm are only dangerous when accompanied by visceral lesions involving the oesophagus, the large vessels, the heart, etc. Only respiratory symptoms are suggestive of a notoriously difficult diagnosis. Ultrasonography appears to be of value. The prognosis depends on associated lesions, which are frequent. The surgical treatment is usually simple, the only problem being the approach. If no complication occurs, sequelae are minimal.

Adolescent↗
PubMed1983

Radiographic assessment of pelvic trauma.

Assessment of pelvic fractures requires an understanding of the bony and soft-tissue anatomy of the pelvis. Pelvic injuries may be classified into major and minor groups. Minor fractures usually result from athletic trauma in the young or falls in the elderly and can generally be adequately evaluated with routine radiography. Major fractures are most often caused by motor vehicle accidents, falls from a height or industrial accidents and require more sophisticated examination. However, the investigation of injuries in either category should be directed by a knowledge of the history and physical findings. The classification of pelvic injuries used at Sunnybrook Medical Centre is based on mechanisms of injury.

Accidents, Traffic↗
PubMedDate not supplied

Epidemiologic features of pelvic fractures.

The epidemiology of pelvic fractures was investigated in Rochester, Minnesota, residents during the decade 1968 to 1977. The overall incidence was 37 per 100,000 person-years, substantially higher than previous population-based studies would indicate. The incidence increased markedly with age in both sexes, and was greater for women than men at all ages over 35, reaching a maximum incidence of 446.3 per 100,000 person-years in women 85 or older. Half of all pelvic fractures were attributed to moderate trauma, usually a fall from standing height, 95% of which were minor (Type I or II). Moderate trauma was responsible for the increase in pelvic fracture incidence with age in the high-risk population of postmenopausal women. A large proportion of both men and women with moderate trauma fractures had some evidence of preexisting osteoporosis.

Accidents↗
PubMed1980

[25 cases of traumatic rupture of the thoracic aorta: current diagnostic elements].

Traumatic rupture of the descending thoracic aorta is lethal within 3 weeks in 95% of patients who do not undergo operation. In this series of 25 patients who were operated on, 84% have survived for 6 years and there have been no cases of paraplegia. The mechanism of injury is most important in the investigation of patients with traumatic injuries and must be sought either from the patient or from witnesses. A history of rapid deceleration (more than 60 km/h) following a highway collision was present in all our cases. Failure to wear seat-belts resulted in 70% of patients being ejected from a vehicle. A side-on collision resulting in lateral deceleration caused trauma to the intrathoracic aorta in 45% of cases. Vertical deceleration resulted from falls from great heights (bridge, overpass) in 25% of cases. Clinical signs of diagnostic importance were: arterial hypertension (60%), systolic murmur (35%) and the pseudocoarctation syndrome (25%). Pertinent signs on chest roentgenograms were present in 95% of cases and included widening of the mediastinum and blunting of the aortic knob. The authors conclude thoracic aortography should be carried out in trauma patients when two or more of the following are present: (a) history of rapid deceleration, ejection from a vehicle or lateral collision, (b) hypertension and (c) blunting or modification of the aortic knob. The presence of a pseudocoarctation syndrome is an absolute indication for aortography.

Accidents, Traffic↗
PubMedDate not supplied

[Suicide in the Geneva canton (1971-1990). An analysis of the forensic medicine autopsy sample].

During the twenty-year period from 1971 to 1990, 1654 cases of suicide were examined at the Institute of Forensic Medicine of Geneva University. The suicide rate for the entire population averaged 22,75 per 100,000 population per annum. The male to female ratio was 1.5:1. The average age was 47. The highest suicide rate lay between ages 27 and 32 for men and between ages 45 and 50 for women. The most common means of suicide chosen by men were the use of firearms (28%) and hanging (21%) whilst women preferentially chose falling from a height (26%), poisoning (24%) or drowning (22%). Carbon monoxide poisoning, the major means of suicide before 1971 (20%), has greatly decreased whereas firearms, formerly representing only 13% of all suicides before 1971, have become the principal means (19%). May, January and September have, respectively, the highest rate of suicide.

Adolescent↗
PubMed1995

Acetabular fractures.

Acetabular fractures are not uncommon injuries of the pelvis. They are most frequently associated with high energy trauma such as that seen in a motor vehicle accident. Management of patients with acetabular fractures includes careful attention to ATLS (advanced Trauma Life Support) protocols and delayed operative treatment of the acetabular fractures. Diagnostic evaluation with plain radiography and CT is used to plan the treatment approach. Treatment includes not only the recognition of the fracture but avoidance of early and late complications. Emergent treatment includes closed reduction of associated hip dislocations followed by skeletal traction. Delayed reconstruction at four days after the injury decreases intraoperative blood loss by allowing retroperitoneal hemorrhage to subside. Final outcome after acetabular trauma depends not only on the reconstruction of the fracture, but the avoidance of complications. Acetabular fractures are becoming an increasingly common orthopedic injury. Fractures of the acetabulum (or hip socket) are most commonly seen after motor vehicle accidents. Young patients (18 to 30 years old) are typically affected. A frequent mechanism of injury is a direct blow to the anterior aspect of the knee with the hip flexed such as a dashboard injury in an automobile accident. Other mechanisms of injury include direct blows to the lateral aspect of the hip as in a fall from a height or a side impact automobile collision.

Accidents, Traffic↗
PubMed1994

Fatal non-transport injuries in Nairobi, Kenya.

Records from the office of the Registrar of Births and Deaths in Nairobi, Kenya, were studied with the aim of determining the magnitude of fatalities due to injuries sustained in the living environment. This information covered the period between 1986 and 1990. Data were collected over a one month period from 3rd July 1991 to 9th August 1991. The information which was collected from the death certificates included type of injury resulting in death, age and sex of the victim. The results from a total of 944 records revealed that males suffered more deaths than females (M:F ratio was 2.67:1). The most commonly occurring type of injury resulting in death was burns (22.5%). This was followed by drowning (18.1%), head injuries (18%) and suicide by hanging (12%). Stab wounds and poisoning (excluding food poisoning) each accounted for 6% of the total deaths, inhalation of vomit (5.2%) and crush injuries due to falling from a height (3.8%). Bullet wounds, asphyxia due to choking, abortion and electrocution each contributed less than 3% of total deaths. The age bracket with the highest number of deaths was between 20 years to 39 year's (51.4%) while infants and children 0-4 years alone contributed 16% of the total deaths. Since non-transport fatalities are common in all age groups, health education programmes must target both children and the adult population.

Adolescent↗
PubMed1994

[Mandibular and maxillary fractures in dogs and cats].

Fractures of the mandible and maxilla are often caused by car accidents or by falling from a height. Frequently the fractures are open, especially when the fracture is located rostrally. During diagnostic work-up, special attention should be given to concomitant injury of the brain, and to cervical and thoracic injuries. The principles of treatment for jaw fractures are identical to those for complicated long bone fractures. Adaptations of techniques are necessary because of the need for undisturbed food intake, the presence of dental elements in the fragments, the poor soft tissue coverage especially in the rostral part of the mandible, and the typical mechanical load of the bones. The dental roots should be avoided when possible. Pharyngostomy prior to fracture treatment allows optimal assessment of the occlusion during surgery. In general, the treatment should permit non-supported food intake by the patient after surgery.

Animals↗
PubMed1993

[Injuries of the cervical spine in children and adolescents].

Ligamentous and osseous injuries of the cervical spine during growth are extremely rare and therapeutic principles for such lesions are ill-defined. In order to help solve some diagnostic and therapeutic problems a retrospective study of 30 children was carried out. There were 5 discoligamentous injuries, 5 fractures of the atlas, 1 fracture of the arcus C2, 8 fractures of the odontoid, and 11 vertebral body compression fractures. The injuries were caused by motor vehicle accident in 9, by diving into shallow water in 7, by falling from a height in 7, by a sports accident in 6, and by a direct trauma in 1 patient. Four children died, three of them due to concomitant brain injury. Two patients suffered permanent neurologic disability due to spinal cord trauma. Five patients underwent an operation. Conservative therapy of flexion-compression fractures of the vertebral bodies caused kyphotic deformity. Ventral interbody fusion in two patients had excellent long-term results. All odontoid fractures were treated by applying a plaster cast and healed promptly. Diagnostic problems were mainly caused by the hypermobility of the upper cervical spine.

Adolescent↗
PubMedDate not supplied

Orthopedic trauma: pelvic fracture.

1. The incidence of pelvic fractures has greatly increased; automobile and motorcycle crashes, pedestrian accidents, and falls from great height are the most common causes. Pelvic fractures caused by high-energy trauma often result in significant morbidity and mortality with mortality rates variously reported at 10% to 50%, dependent upon fracture classification and associated injuries. Mortality occurs from associated trauma to viscera, abdominal organs, and abdominal vessels, and from early complications of hemorrhage. 2. The difficulty in management of patients with pelvic fractures is determining whether fractures are stable or unstable. Single breaks with no displacement in the pelvic ring, which includes injuries to the ischium, ilium, pubis, and sacrum, are stable fractures and account for one third of all pelvic fractures. 3. Increasingly widespread use of surgical stabilization internally via rigid fixation of pelvic fractures has helped reduce the morbidity and mortality related to these fractures. Other benefits that have resulted include shortened hospitalization, decreased complications, and earlier mobility.

Fractures, Bone↗
PubMed1993

Transpedicular screw-rod fixation in the treatment of unstable lower thoracic and lumbar fractures.

A total of 41 consecutive cases of unstable lumbar and lower thoracic spine fractures or fracture dislocations were treated by the authors at the Soroka Medical Center, Beer-Sheva, Israel between 1988 and 1992, using the Dick Internal Fixator, for reduction of the deformity and fixation. Twenty-nine of the 41 cases, 19 males and 10 females with an average age was 30.5 years, had a mean postoperative follow-up of 24 months Their injuries, 44 fractured vertebrae, were due to road traffic accident in 11 instances, falls from a height in 11 (of whom 4 were suicide attempts), work accidents in 6, and gunshot wound in 1. Among the vertebral injuries, 3 patients sustained a two-column injury and 26 a three-column injury, according to the Denis classification. Reduction of the kyphotic deformity was achieved, obtaining the proper height of the injured vertebra or reduction of the fracture-dislocation, and assuring a proper fixation, using a bilateral transpedicular screw-rod fixation system. Neurological improvement occurred in 9 cases of the 18 who had neurological deficit at admission. According to Frankel's criteria, these patients had an average of 1.125 Frankel's grade improvement; three of these patients recovered completely. There were no operative or postoperative deaths. Major complications included one case of major postoperative gastrointestinal bleeding, one case of pulmonary emboli, and two cases of deep wound infections. This study recommends the use of the Dick Internal Fixator for the correction of major spinal deformities due to its greater structural rigidity and greater availability of bone surfaces for fusion.

Adolescent↗
PubMed1977

[Diaphragmatic lesions in closed injury].

Bases on the analysis of 10 clinical observations, it was found that closed injuries of the diaphragm occur mainly in the use of great mechanic force (compression, a fall from great height, an impact of quick-acting object). In the acute period these are frequently not accompanied by diaphragmatic hernia and remain unrecognized. It is the author's opinion that in early diagnosis of acute diaphramatic hernia clinical symptoms play no leading role, but chest roentgenography is of primary importance. The terms of surgical treatment and the choice of the operative access are determined by general patient's state and the character of associated lesions.

Abdominal Injuries↗
PubMed1995

The odontoid synchondrotic slip: an injury unique to young children.

We report seven children (three female, four male) diagnosed with traumatic synchondrotic slip of the odontoid. The clinical records, plain films and CT scans were evaluated retrospectively. The patients ranged in age between 3 and 5 years. Their injuries resulted from a motor vehicle accident in four cases and from a fall from a height in three. The injury was isolated in five; it was associated with a closed head injury in one and with facial and brachial plexus trauma in another. Radiographs showed anterior angulation with or without displacement in all seven cases. Axial CT with sagittal reformation and 3D reconstructions were performed in six cases. This confirmed the synchondrotic slip and, in addition, identified a rotary component to the injury in three cases, with compromise of the canal in two. Other additional injuries were also noted. All cases were treated conservatively and the injuries healed. Only one child had a neurological deficit attributable to her head injury rather than her cervical injury (MR of the cervical cord was normal). The presence of the synchondrosis between the dens and the body of C-2 makes this injury unique to children under 7 years of age; by the age of 7 the synchondrosis has fused.

Child, Preschool↗
PubMed1996

Multiple carpometacarpal dislocations. A case report and review of treatment.

Carpometacarpal dislocations of the ulnar four joints are rare injuries that are usually associated with high-energy trauma. Given the small number of cases reported, there exists some controversy regarding their optimal management. The case of a 27-year-old man who sustained a dorsal dislocation (without associated fractures) of the ulnar four carpometacarpal joints as a result of a fall from a height is presented. The literature regarding these hand injuries is reviewed, and the need for anatomic reduction and stabilization is discussed.

Acetabulum↗
PubMed1996

[Case report on management of grade 4 infected open comminuted tarsus fracture by tibio-Chopart arthrodesis].

We report on the treatment of a 39 year old patient who suffered from subtotal amputation of the middle foot area after fall from tall height. He was treated by an arthrodesis between ventral tibia and distal Chopart-joint which was carried out as late-primary care. Therefore calcaneus and talus were totally and os cuboideum and os scaphoideum were partially removed. This form of arthrodesis is a rare indication. With remaining blood flow and sensibility in the fore foot it is an alternative to amputation/exarticulation in the tibiotalar joint. Advantages are the improved plantar weightbearing area, a simplified supply of orthopedic shoes and a better tactile ground contact.

Adult↗