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PubMed1982

[Classification, treatment and results of fractures of the tibial pilon].

Considering the rate of complications and the remaining disability occurring after compression fractures of the distal end of the tibia - the so-called pilon fracture -, this type of fracture is one of the most serious injuries of the lower extremity. Such fractures of the distal end of the tibia can be caused by compressions as well as by direct of indirect traumatic violence, e.g. shearing, bending, or torsion effects. Of 102 patients with pilon fractures, 63 (= 61.8%) suffered this fracture by falling from a great height. When classifying our cases with fracture of the distal end of the tibia, and the diagnosed accompanying injuries, we found a dependence between expected consequences of the lesion and the seriousness of the accident before surgery already. During the treatment of patients suffering from pilon fractures, complications arose in 0% of group I, in 16.1% of group II, and in 27.6% of group III. With respect to the existing possibilities of surgical treatment of fractures, one should always - if possible - reconstruct the joint surfaces in an anatomically correct manner and apply an early functional treatment with late exertion of stress on the injured part.

Adult↗
PubMed2003

Predicting the failure load of the distal radius.

The distal radius is an important site for the early detection of patients at risk for fracture. Since measuring bone strength in vivo is not possible, we evaluated which bone assessment method of the forearm would best predict failure load of the distal radius and computed a factor of risk for wrist fracture (Phi wrist). Thirty-eight cadaveric forearm specimens were measured by five different techniques to assess bone density, bone mineral content, geometry and trabecular structure at the distal forearm. The bone assessment techniques included dual-energy X-ray absorptiometry (DXA) of the radius, peripheral quantitative computed tomography (pQCT) of the 4% and 20% distal sites of the radius, DXA of the phalanges, digital X-ray radiogrammetry of the forearm (DXR-BMD), and quantitative ultrasound of the radius. The failure load of each excised radius was determined by simulating a fall on an outstretched hand. The pQCT measurements of polar stress-strain index and cortical content explained the greatest portion of variance in failure load (r2=0.82-0.85). Bone mineral content measures were generally better predictors of failure load (r2=0.53-0.85) than the corresponding volumetric or areal bone mineral density values (r2=0.22-0.69) measured by either pQCT or DXA. Multiple regression analysis showed that the addition of a bone geometry measure improved the ability of a bone density measure alone to predict failure load. There was high variability in the ability of different techniques and different variables within a given technique to predict failure load. Estimates of the factor of risk for wrist fracture (Phi wrist) revealed that the women in this study would have been likely to fracture their distal radius upon falling from a standing height (Phi wrist= 1.04), whereas the men would have likely withstood the impact without fracturing their wrist (Phi wrist= 0.79).

Absorptiometry, Photon↗
PubMed1993

Ipsilateral fractures of the scaphoid and radius.

From 1985 to 1990, six patients were treated for ipsilateral fractures of the scaphoid and radius. All these injuries resulted from falls from a substantial height, with multiple injuries occurring in all patients. Two of the patients had minimally displaced fractures (1.0 mm), whereas the other four patients had moderately displaced scaphoid fractures (2.0 mm). The treatment for fracture of the distal radius was dependent on the fracture type, but all the scaphoid fractures were treated with internal fixation. All the fractures united, with the radial fractures healing in 6 weeks and the scaphoid fractures healing in an average of 13 weeks. The follow-up time averaged 2.9 years (range, 1.0 to 4.6 years). Internal fixation of the scaphoid in these combined injuries allowed for earlier and more aggressive therapy to maximize wrist and forearm motion.

Adolescent↗
PubMed2004

Pathologic features of suicidal complete decapitations.

Despite high suicide rates all over the world, complete decapitation as a consequence of violent suicide methods is exceptionally rare and there is always a potential for confusion with homicide as well as with body dismemberment or mutilation. We analyzed the phenomenology and morphology of 10 cases (six male, four female; individual age 18-60 years) of suicidal complete decapitation that were subjected to medico-legal autopsies at the Institute of Legal Medicine, University of Hamburg, Germany, between 1995 and 2002. All decapitations occurred while the person was alive as proven by signs of vitality. Blood alcohol levels were positive in five cases and ranged between 28 and 202 mg/dl. The applied methods of suicide were running over by a train in eight cases and hanging in two cases. In suicidal hanging resulting in complete decapitation the wound margins were clear-cut with an adjacent sharply demarcated circumferential band-like abrasion zone showing a homogenous width, the latter determined by the thickness of the rope. In decapitations due to railway interference a broad spectrum of pathologic alterations such as the co-existence of irregular, ragged and sharp-edged wound margins, vascular and nervous pathways forming bridges in the depth of the wound and bruising could be observed. In such cases skin abrasion zones were generally not circumferential and showed a heterogenous width. Concerning hanging-related complete decapitations, our findings are well in line with those of other authors, namely that heavy body weight of the suicidal, fall from a great height and in some cases inelastic and/or thin rope material used for the noose are the determining factors decisive for complete decapitation.

Adolescent↗
PubMedDate not supplied

Trauma in elderly people: what proportion of fractures are a consequence of bone fragility?

Epidemiologists have tended to equate osteoporotic fractures with those which occur after only moderate trauma, or which affect elderly people. We set out to critically examine this epidemiological approach, because even among elderly people some fractures will be a result of severe trauma and these cannot be assumed to reflect bone fragility. In a population based study of all Cardiff residents aged over 60 we identified everyone who presented with a fracture during 1996. We considered the events that led to each fracture, to establish which fractures were a result of 'severe' trauma: trauma greater than a fall from a standing height. We identified 1335 people who between them sustained a total of 1372 fractures. 168 (12%) of the fractures resulted from severe trauma, but in people aged over 80 only 6% of all fractures, 4% of hip fractures, and 3% of wrist fractures followed severe trauma. In older subjects severe trauma makes only a very small contribution to the causation of fracture, so that the age-sex distribution of fractures following moderate trauma closely resembles that of fractures overall. For epidemiological purposes it does appear justifiable to equate the consequences of bone fragility with the occurrence of osteoporosis associated fractures in elderly people.

Journal Article↗
PubMed1999

Decapitation as a result of suicidal hanging.

A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. Death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).

Craniocerebral Trauma↗
PubMed2003

Traumatic dysfunction of the optic chiasm.

BACKGROUND: Trauma of the optic chiasm has been reported but its incidence is low. PATIENTS AND METHODS: Retrospective review of patients diagnosed with traumatic optic neuropathy between 1992 and 2002. RESULTS: Among 91 patients with a diagnosis of traumatic optic neuropathy, 10 showed evidence of optic chiasm involvement. All were males, the average age was 32 years (range 22-43). Injuries resulted from a rapid deceleration in 8 cases (car or motorcycle accident or fall from a minimum height of 5 meters). Coma was present in 6 cases and neurologic disorders in 8 cases. Optic neuropathy was present in 8/10 cases. Visual improvement was noted in two patients who suffered from milder head trauma. CONCLUSIONS: Optic chiasm dysfunction following head trauma is not that rare, as 11 % of our traumatic optic neuropathy group presented such a dysfunction. In some cases the visual field defect was obvious, but in some others it was more subtle. Visual prognosis was generally poor, probably related to the the severity of the impact.

Adult↗
PubMed1997

Safety Level of Acrobatic Work: A Probabilistic Study.

Acrobatic work constitutes an activity during which individuals intervene on buildings, cliffs, towers, and so forth, through the use of mountaineering or speleological techniques. The most dangerous situations occur particularly when ascending a rope with ascenders or roping with a descender. Any free fall or false manoeuvre will result in a strong shock on the belaying system that may cause its rupture. The fatal accident rate (FAR) of a given occupation is defined as the average number of fatal accidents per 108 hrs of exposure to a given hazard. In this study it is assumed that the FAR is proportional to the average number of fall-initiating events, η, per worker and per hour of exposure to the fall hazard. η is estimated to be between 10-3 and 3 × 10-3. The maximum values of the rupture probability of the securing systems are calculated for the FAR of acrobatic work to be smaller than the FAR of the three most dangerous activity groups of the construction industry in France. These values allow the varying ranges of the parameters that influence this rupture probability to be determined.

acrobatic work↗
PubMed1999

Release kinetics of cardiac troponin I and cardiac troponin T in effluents from isolated perfused rabbit hearts after graded experimental myocardial contusion.

BACKGROUND: Few experimental studies report effects of direct contusion on cardiac enzyme release. Cardiac troponins I (cTnI) and T (cTnT) have been shown to be highly sensitive and specific markers of myocardial cell injury. This investigation was designed to determine and compare the acute effects of quantified magnitudes of blunt cardiac trauma upon release of cTnI and cTnT in comparison with creatine kinase (CK) and lactate dehydrogenase (LD). METHODS: In 24 rabbit hearts prepared on a standard Langendorff apparatus, myocardial contusion (MC) was produced by a single blow with a ball falling from a predefined height, delivered directly to the surface of the heart. Hearts were divided into control (n = 6) and various quantified impacts: 75 mJoules (mJ) (n = 6), 100 mJ (n = 6), 200 mJ (n = 6). Coronary effluent samples for cTnI, cTnT, CK, and LD were collected at baseline, immediately after MC and 5, 15, 30, 45, and 60 minutes after MC. At the end of experiment, histologic condition was evaluated. RESULTS: The anti-cTnI and cTnT MAbs used in the cTnI (Access) and cTnT (Elecsys) assays cross-react with cTnI and cTnT of the rabbit. The time-courses of cTnI, cTnT, CK, and LD were monophasic in form. After MC, all parameters rose significantly compared with baseline and with control group. The maximal release occurred immediately after MC. The area under the cTnI curve and the maximal cTnI concentration were linked to the contusion energy when increased at 200 mJ. Maximal concentrations and areas under cTnT, CK, LD time activity curve were not linked to the contusion energy level and showed no between-energy group differences. The correlation found between maximal cTnI and maximal cTnT concentrations was 0.70 (p = 0.0001). Histologic examination showed cellular disruption and after the more severe impact, the extent of pathologic changes was more extensive. CONCLUSION: After graded experimental MC, maximal cTnI concentration and area under cTnI curve increase with the power of impact kinetic energy. Levels of cTnI allow a much higher accuracy in detecting the extent of myocardial injury postMC in comparison with cTnT, CK, and LD in this experimental study. These results should be consistent with the more extensive cTnI release with more severe impact in patients with blunt chest trauma. Furthermore, because specificity and time-course of release, both cTnI and cTnT should have a role in the diagnosis and evaluation of such patients.

Animals↗
PubMed2002

Spinal injuries.

The pre-hospital care of patients with suspected spinal injuries involves early immobilisation of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disruption. Early ventilation and differentiation of haemorrhagic from neurogenic shock are the key elements of pre-hospital resuscitation specific to spinal injuries. Falls from a significant height, high-impact speed road accidents, blast injuries, direct blunt or penetrating injuries near the spine and other high energy injuries should all be regarded as high risk for spinal injury but clinical examination should determine whether the patient requires full, limited or no spinal immobilisation. Although there is little conclusive evidence in the literature that supports pre-hospital clinical clearance of the spine, the similarities between pre-hospital immobilisation decisions and in-hospital radiography decisions are such that it is likely that clinical clearance will be effective for selected patients. This decision can be made at the scene provided the patient has no evidence of: Altered level of consciousness or mental status Intoxication Neurological symptoms or signs A distracting painful injury (e.g. chest injuries, long bone fracture) Midline spinal pain or tenderness. Where there is evidence to support spinal immobilisation, then the full range of devices and techniques should be considered. In the remote or operational environment where pre-hospital times are prolonged, full immobilisation, analgesia and re-assessment may allow localisation of the injury and a reduction in the degree of immobilisation. Common reasons for missing significant spinal injuries include failing to consider the possibility of spinal injuries in patients who are either unconscious, intoxicated or uncooperative (54,55). The application of the decision rule discussed here will ensure that no clinically significant spinal injuries are missed in pre-hospital care.

Emergency Medical Services↗
PubMed2006

Running over rough terrain: guinea fowl maintain dynamic stability despite a large unexpected change in substrate height.

In the natural world, animals must routinely negotiate varied and unpredictable terrain. Yet, we know little about the locomotor strategies used by animals to accomplish this while maintaining dynamic stability. In this paper, we perturb the running of guinea fowl with an unexpected drop in substrate height (DeltaH). The drop is camouflaged to remove any visual cue about the upcoming change in terrain that would allow an anticipatory response. To maintain stability upon a sudden drop in substrate height and prevent a fall, the bird must compensate by dissipating energy or converting it to another form. The aim of this paper is to investigate the control strategies used by birds in this task. In particular, we assess the extent to which guinea fowl maintain body weight support and conservative spring-like body dynamics in the perturbed step. This will yield insight into how animals integrate mechanics and control to maintain dynamic stability in the face of real-world perturbations. Our results show that, despite altered body dynamics and a great deal of variability in the response, guinea fowl are quite successful in maintaining dynamic stability, as they stumbled only once (without falling) in the 19 unexpected perturbations. In contrast, when the birds could see the upcoming drop in terrain, they stumbled in 4 of 20 trials (20%, falling twice), and came to a complete stop in an additional 6 cases (30%). The bird's response to the unexpected perturbation fell into three general categories: (1) conversion of vertical energy (EV=EP+EKv) to horizontal kinetic energy (EKh), (2) absorption of EV through negative muscular work (-DeltaEcom), or (3) converting EP to vertical kinetic energy (EKv), effectively continuing the ballistic path of the animal's center of mass (COM) from the prior aerial phase. However, the mechanics that distinguish these categories actually occur along a continuum with varying degrees of body weight support and actuation by the limb, related to the magnitude and direction of the ground reaction force (GRF) impulse, respectively. In most cases, the muscles of the limb either produced or absorbed energy during the response, as indicated by net changes in COM energy (Ecom). The limb likely begins stance in a more retracted, extended position due to the 26 ms delay in ground contact relative to that anticipated by the bird. This could explain the diminished decelerating force during the first half of stance and the exchange between EP and EK during stance as the body vaults over the limb. The varying degree of weight support and energy absorption in the perturbed step suggests that variation in the initial limb configuration leads to different intrinsic dynamics and reflex action. Future investigation into the limb and muscle mechanics underlying these responses could yield further insight into the control mechanisms that allow such robust dynamic stability of running in the face of large, unexpected perturbations.

Analysis of Variance↗
PubMed1998

A review of nondestructive test methods and their application to measure the stability and osseointegration of bone anchored endosseous implants.

Threaded and cylindrical metallic endosseous implants are being used increasingly in cranio-facial, dental, and orthopedic surgery. There is a significant need for the development of quantitative noninvasive test methods to measure implant stability and success. Such success can be quantified by measurements of the stiffness and damping of an implant in the surrounding bone, and also the height of the marginal bone around an implant. In the case of a failing implant, the bone around it is replaced by fibrous tissue, and in the case of an overloaded implant the bone height around the implant falls. Nondestructive test methods have been applied to the testing of implant and tooth mobility, and commonly these have used transient or steady-state test methods. Transient methods entail tapping an implant, measuring its response and then performing a Fast Fourier Transform to resolve the fundamental frequencies. Steady-state methods measure the frequency response of a system using a swept frequency wave form. A number of dedicated electronic instruments have been designed to perform these tasks, and this article discusses their applications, accuracy, and value as clinical diagnostic instruments.

Biocompatible Materials↗
PubMed1996

Coronal shear fractures of the distal end of the humerus.

We identified a shear fracture of the distal articular surface of the humerus, with anterior and proximal displacement of the capitellum and a portion of the trochlea, in six patients (five female and one male). The average age of the patients was thirty-eight years (range, ten to sixty-three years). Each fracture was the result of a fall from a standing height. A characteristic radiographic abnormality, which we have termed the double-arc sign, was seen on the lateral radiograph of each patient and represented the subchondral bone of the displaced capitellum and the lateral trochlear ridge. All patients were managed with open reduction, internal fixation, and early motion of the elbow. The average duration of follow-up was twenty-two months (range, eighteen to twenty-six months). The fracture united in all patients at an average of six weeks (range, four to nine weeks), without radiographic evidence of osteonecrosis of the fracture fragment. Flexion of the elbow averaged 141 degrees (range, 130 to 150 degrees), with an average flexion contracture of 15 degrees (range, 0 to 40 degrees). Pronation of the forearm averaged 83 degrees, and supination averaged 84 degrees. All patients had a good or excellent functional result, according to the elbow-rating scale of Broberg and Morrey.

Activities of Daily Living↗
PubMed1975

Biomechanical responses to open experimental spinal cord injury.

This study evaluates the dynamic biomechanical responses of the cat spinal cord during experimental impact injury. Temporal deformations of the laminectomized spinal cord were recorded by a high speed camera (1500-3000 frames/sec). The cinematograph revealed large deformations, the cord being compressed to half its posterior-anterior diameter 7 msec after the onset of the impact. Peak impact force produced by a 20 gm mass falling from 15 cm height (300 GCF) averaged about 1.2 pounds, and the corresponding stress acting on the dural surface reached 42 pounds per square inch (or 2200 mm Hg). Both positive and negative pressure waves were found to be propagated in the cerebrospinal fluid.

Animals↗
PubMed1992

[Vertebral fractures and abdominal trauma. A retrospective study based on 415 documented vertebral fractures].

415 spinal fractures were analysed retrospectively. A simultaneous occurrence of vertebral fracture and abdominal trauma was found in 14 patients (3.4%). The mechanism of injury was a fall from a considerable height in 9 cases, a car accident in 3 and a motorcycle accident in 2. Isolated fractures of the transverse processes and rotational injuries of the spine were found to be associated particularly frequently with an abdominal trauma (3 of 14 isolated fractures of the transverse processes = 22%, 5 of 61 rotational injuries = 8.2%), while compression injuries only showed such a simultaneous abdominal injury in 2% of the 300 fractures of this type. We never encountered the combination of distraction injury/abdominal trauma. This is probably because two-point lap-type seat belts are only rarely used in our country. In 2 patients with rotational injuries neurological deficits were observed. The abdominal injuries encountered in our patients were: massive concussion of the kidney (6 cases), rupture of the spleen (3 cases), rupture of the liver (2 cases), rupture of the mesocolon (2 cases), rupture of the caecum (1 case), rupture of a pre-existent aneurysm of the aorta (1 case), rupture of a renal artery (1 case), massive retroperitoneal haematoma (1 case). Other injuries were present in 12 of the 14 patients: 3 craniocerebral injuries, 7 fractures of the long bones, 6 injuries to the thorax and 3 to the pelvis. In conclusion, a simultaneous finding of vertebral fracture and abdominal trauma is rare in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMedDate not supplied

[Death by a cleaning pig--an unusual accident at work].

A worker was killed operating on a natural gas pipeline. At a receiver station the man intended to pick up two so called cleaning pigs, each weighing about 150 kg, diameter 0.5 m. For this purpose the gas pressure in the pig trap was let off by a valve, manometer controlled. According to an eyewitness's statement, the receiver pressure was equal to outside air pressure before the accident. The victim stood right in front of the flap of the receiver when he began to unfix the screws of the flap. Whilst working, the flap snapped out driven by the two cleaning pigs. The man and the devices were flung through a wire-netting fence and dropped down on a nearby field at a distance of 27, 29 and 38 m, respectively, from the receiver. The man died on the scene of the accident. The forensic autopsy ordered by the prosecution revealed signs of massive blunt trauma on the head, thorax and abdomen. In the criminological and forensic reconstruction of the accident the external injuries of the victim were found to be consistent with the front surface of the cleaning pig flung out first. It was determined that the second pig had got stuck in the receiver and that gas pressure had built up behind the pigs due to a leaky valve. As a consequence the pigs were expelled at a velocity of approximately 220 km/h causing a pattern of injury comparable to that of a fall from a great height.

Accidents, Occupational↗