Injury最新文献

Objective: Our primary objective was to identify and describe demographic trends in head and neck injuries incurred while participating in horseback riding.

Study design: Cross-sectional analysis.

Setting: National Database.

Methods: Head and neck injuries related to horseback riding over a ten-year period (2014-2023) were analyzed using data from the National Electronic Injury Surveillance System (NEISS). A total of 3,177 cases were identified. Inclusion criteria encompassed injuries to the head, neck, face, mouth, or ear. Variables included age, gender, injury type, anatomical location, and patient disposition. Chi-squared analyses were employed to compare the aforementioned injury variables.

Results: Among the 3,177 reported injuries of males and females, females (mean age 27.51 years, SD = 19.04) were more likely to be treated and released (83.29 %, n= 2023), while males (mean age 34.65 years, SD = 22.58) were more likely to be hospitalized. There was a significant association between gender and concussion diagnosis (p<.001), with females more likely to be diagnosed with concussions (n = 687) compared to males (n = 129). Females experienced more head and face injuries compared to males. Age distribution varied significantly across disposition categories, indicating different management practices for various age groups. The dataset indicates that the average age of females (27.51 years) is notably lower than that of males (34.65 years), suggesting a younger demographic among females overall.

Conclusions: The study highlights a significant gender disparity in horseback riding-related head and neck injuries, with females more likely to be treated and released and males more often requiring hospitalization.

Introduction: External fixators are utilized to temporarily stabilize bicondylar tibial plateau fractures. They can be prepped during definitive surgery to help maintain fracture length and alignment. However, there is a potential for increased infection by leaving the external fixator on during the surgery. We hypothesize that maintaining the external fixator during surgery will result in no difference in rates of deep infection but improve reduction quality.

Methods: We performed a retrospective cohort study of all bicondylar tibial plateau fractures treated at an academic, level one trauma center over a 10-year period. The primary outcome analyzed was the rate of deep infection. Secondary outcomes analyzed included reduction quality by comparing the medial proximal tibia angle (MPTA) and posterior proximal tibia angle (PPTA), complication rate, and reoperation rate.

Results: One hundred and thirty-nine fractures in 133 patients met the inclusion criteria. There was no difference between the external fixator removed and prepped groups in terms of baseline patient characteristics except for more motor vehicle collisions in the removed group (42 % vs 22.99 %, p = 0.0193) and more open fractures in the prepped group (6 % vs 18.39 %). Operative characteristics were also not statistically different except for more patients in the prepped group underwent preoperative skin shaving (22 % vs 48.28 %, p = 0.0023) and more patients in the removed group had fixation constructs with plate and pin site overlap (46 % vs 24.14 %, p = 0.0083). There was no difference in deep infection between the groups (16.00 % vs 8.05 %, p = 0.1511). There was no difference in reduction quality when comparing the MPTA (87.64° vs 87.40°, p = 0.6607) and PPTA (83.18° vs 83.97°, p = 0.3592). The rates of superficial infection (20 % vs 29.89 %, p = 0.2056), unplanned reoperation (30 % vs 18.39 %, p = 0.1179), complications (58 % vs 44.83 %, p = 0.1376), and nonunion (8 % vs 6.89 %, p = 0.8111) were also similar.

Conclusions: Bicondylar tibial plateau fractures are challenging injuries with a high complication profile. Our findings suggest that maintaining the external fixator is not associated with increased rates of deep infection or complications. However, maintaining the external fixator during surgery did not lead to differences in final coronal or sagittal alignment reduction quality.

Background: Proximal femoral fractures has been associated with high mortality risk, while little is known about more distal lower extremity fractures. The aim was to report 30- and 365-days mortality in surgically treated lower extremity fractures in individuals above 65 years.

Materials and methods: We extracted data from the Danish National Patient Register on all surgically treated lower extremity fracture in the period 1998-2017. The primary outcome was mortality reported by fracture site defined by ICD-10 codes (femur S72*, tibia S82*, foot/ankle S92*S825-8). The secondary outcomes were mortality divided on sex, age groups (5-year span), and comorbidity. This study was conducted using descriptive statistics.

Results: We identified 182,013 operatively treated lower extremity fractures of which 73 % occurred in females. The 30-day mortality was 10 % for patients with femoral fractures, 2 % for tibia and 1 % for foot/ankle. The 30-day mortality were similar in femoral fractures regardless of location in the femur (8-11 %). The 365-day mortality was 29 % for femoral fractures, 8 % for tibia and 6 % for foot/ankle. Men with a femoral fracture had higher mortality (15 % at 30 days, 37 % at 356 days) in comparison to women (8.2 % at 30 days, 26 % at 356 days). For the above 85+ year age group, the fracture location was less important for 365-day mortality.

Conclusion: There was an observed high risk of mortality in surgically treated femoral fractures. The mortality risks seems to rapidly decline when the fractures are below the knee.

Background: Unstable posterior pelvic-ring fractures are rare and difficult to manage. There are many injury patterns, they are associated with high morbidity and mortality, and optimal surgical management remains contentions. This study aims to compare outcomes and complications for different surgical management of these injuries.

Methods: This was a multi-centre observational study of patients with traumatic posterior pelvic-ring injuries that underwent operative management between 1st January 2010 and 1st January 2020 at three Australian MTS. Cases were identified using internal hospital databases and the Victorian State Trauma registry. Data was retrieved from medical records and included surgeries, fixation method, length of stay, and outcomes (revision surgery, infection, hardware breakage, screw misplacement and hardware removal), time to each outcome was also recorded. The extracted data was collated and then analysed using RStudio; generalised liner models and linear regression models were developed to calculate mean differences and odd ratios.

Results: There were 439 cases (309 males and 130 females) in the cohort with a median age of 39 years. The overall prevalence of revision was 7.7 %; 4.8 % for infection, 1.8 % for hardware failure and 13.2 % for removal of hardware. Bulkier, more prominent fixation methods had higher rates of metalware removal. Numbers were too small in subgroups to detect a significant difference in complication rates between fixation method. However, bilateral injuries had a significant effect on revision with a calculated prevalence of 16.7 % vs 5.6 % for unilateral injuries. Cases managed with open-reduction had a calculated infection rate of 15.6 % vs 4.6 %. Length-of-stay was increased in patients managed with temporising external fixators, who had bilateral injuries, where infection occurred or were restricted to non-weight bearing postoperatively.

Conclusions: This study highlight bilateral posterior-pelvic ring injuries as a greater management challenge than unilateral injuries. It supports the use of percutaneous fixation with closed-reduction, decreased infection risk and decreased length-of-stay. It challenges the use of external fixators and supports less restrictive post-operative restrictions. This study also serves as a descriptive analysis for the current management of pelvic fractures in an Australian setting, shedding light on complication rates and profiles.

Background: Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols.

Methods: A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies.

Results: The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive.

Conclusion: Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.

Introduction: Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.

Methods: Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.

Results: The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, p < 0.001) and LG (96.8 ± 3.2 %, p < 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (p < 0.001), though it did not reach levels comparable to the MD and LG groups (p > 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (p < 0.001), while no difference was observed in coronal implant alignment.

Conclusion: These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.

Background: Older adults make up an increasing portion of orthopedic trauma care. Proxy reports are particularly valuable when patients face difficulties formulating answers due to pre-existing or temporary cognitive impairment, and provide critical insights into patient well-being.

Questions/purposes: This study examines the agreement between patient- and proxy-reported outcome measures across various health domains of older adult orthopedic trauma patients, including those with mild cognitive impairment.

Patients and methods: A prospective cohort study was conducted in the Orthopedic trauma clinic of two Level 1 trauma centers, involving 108 patients aged 70 years or older, with or without mild cognitive impairment, and a self-identified discernible proxy. Participants were evaluated using PROMIS measures for physical function, pain intensity, anxiety, depression, fatigue, and social roles and (instrumental) activities of daily living questionnaires. Agreement between patient and proxy assessments was analyzed using Intraclass Correlation Coefficient and Bland-Altman analyses. Subgroup comparison was made using confidence intervals.

Results: Most patients were married women with a mean age of 78 years (SD 6.2), 61 % had higher education, 67 % were walking independently, and 53 % had fractures of the pelvic ring or femur. Proxies were younger (mean age 64 years, SD 15), with 41 % being children and 40 % spouses. Significant correlations were found between patient and proxy assessments in physical function (ICC 0.74, 95 % CI 0.61-0.82), pain intensity (ICC 0.83, 95 % CI 0.74-0.89), (instrumental) activities of daily living (both ICC 0.86, 95 % CI 0.80-0.91). Moderate correlations were observed in anxiety, depression, fatigue, and participation in social roles (ICCs ranging from 0.56 to 0.66). Bland-Altman analyses confirmed good agreement with none to minimal systematic bias across all these domains.

Conclusion: Proxy-reported outcomes are valuable for evaluating health domains in older adult orthopedic trauma patients, including those with cognitive impairments. While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. Future research should explore longitudinal agreements to better understand recovery perceptions over time and mitigate bias proxy-reporting, ultimately enhancing both patient care and outcomes research in geriatric orthopedic trauma patients.

Objectives: The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.

Methods: Design: Prognostic Level IV SETTING: Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.

Intervention: 3D reconstructions of the pelvis were created, and a virtual 3.5 mm cylindrical implant was placed from the pubic tubercle to the lateral cortex of the ilium. Success was defined as a bicortical virtual screw path from the ramus to the lateral ilium without cortical perforation. The cylinder was then expanded to model varying screw diameters. We then repeated this same process for unicortical retrograde screw insertion ending medial to the acetabular joint.

Main outcome measures: Successful screw placement and maximum screw diameter.

Results: A 3.5 mm screw was successfully placed in 187 patients (93.5 %). One male (1/107, 0.9 %) and 12 females (12/93, 12.9 %) could not accommodate a 3.5 mm screw. All cases of perforation occurred lateral to the obturator foramen. Increasing height was associated with success, and male gender was associated with the ability to accommodate screws with a diameter 6.5 mm and larger.

Conclusions: Most patients can accommodate a 3.5 mm screw from the pubic tubercle to the ilium. Height and gender should be noted when planning medullary ramus fixation.

Background: Fragility fractures of the pelvis are becoming increasingly important in an ageing society. However, they are under-represented in the current research literature. In particular, unstable bilateral fragility fractures of the sacrum (FFP IVb) benefit from surgical treatment, but individual fracture patterns need to be considered in the surgical decision. This study describes the sacral anatomy in patients with FFP IVb pelvic fractures, with particular emphasis on the identification and evaluation of possible trans-sacral screw corridors, with particular emphasis on the transverse fracture components.

Methods: Design: Retrospective clinical study.

Setting: Level 1 trauma center. Patient Selection Criteria: The study reviewed 100 patients admitted for bilateral FFP with a transverse fracture between 01 / 2013 and 11 / 2023 that had a preoperative computed tomography (CT) of the pelvis including the fifth vertebra, treated with FFP IVb using preoperative multiplanar CT scans to analyze sacral anatomy. Outcome Measures and Comparisons: Sacral types and transitional abnormalities were classified, and corridor dimensions for S1 and S2 were measured, including estimated bone density using Hounsfield units. Bone corridors ≥ 8 mm were considered adequate. In addition, possible trans-sacral screw corridors were evaluated, taking into account the transverse fracture component.

Results: While large trans-sacral screw corridors (≥ 8 mm) for S1 and S2 were identifiable in most cases, the actual feasibility for screw placement was limited due to the transverse fracture component's location, resulting in meaningful corridors in only 80 % for S1 and 47 % for S2. Additionally, in 4 % of patients without an S1 corridor, trans-sacral screw fixation was deemed inadequate due to the fracture line passing through S2.

Conclusions: These results indicate that not all FFP IVb fractures can be effectively stabilized using trans-sacral screw or bar fixation, necessitating alternative techniques for some cases. Furthermore, precise preoperative planning is essential for the management of these fractures due to complexity of anatomy. To identify the most suitable treatment approaches, further clinical studies are required.

Level of evidence: III.

Background: Boxing is a sport well-known for the risk of injury. However, the epidemiology of boxing-associated fractures has not been well studied. This study aims to report the characteristics of boxing fractures that lead to presentation to the emergency room and evaluate the demographics and practices of the patients to prevent these injuries.

Methods: This cross-sectional study analyzed boxing-associated fractures over a decade (2013-2022) using the National Electronic Injury Surveillance System (NEISS) database. Patients presenting to U.S. emergency departments with boxing-related injuries were categorized by age, gender, and injury location. Descriptive statistics, chi-square tests, and ANOVA were employed to assess temporal trends and associations between injury occurrence and demographic variables.

Results: Analysis of 959 boxing-associated fractures (BAFs) showed that hand fractures were most common (53.64%), followed by phalanx (12.73%) and facial fractures (10.91%). Significant differences were observed across body parts (χ2 = 9.74, P < .001). Associated soft tissue injuries included lacerations, contusions, sprains, strains, and hematomas, with no significant differences among these categories (χ2 = 1.47, P = 0.832). Males experienced more BAFs than females overall, but females had a significant increase over time (F(1,9) = 4.308, p = 0.032). Most fractures occurred in recreational or sports settings (34.5%), followed by home (19.1%) and school (13.24%). The highest BAF incidence was in individuals aged 21-30 (32.18%), while the lowest was in those aged 41-50 (5.47%). From 2020 to 2022, BAFs decreased in recreational settings and increased at home during 2020-2022.

Conclusion: Hand fractures were the most common type of BAF. Males had significantly more BAFs, although the incidence of BAFs in females increased significantly since 2013. Fractures mainly occurred in recreational places, but from 2020-2022, most occurred at home. This shift coincided with the COVID-19 pandemic, suggesting increased home sparring. These findings emphasize the need for further research into protective measures and injury prevention in boxing.