Neck Fractures Research Articles

Decreasing incidence of cervical spine fractures in patients with ankylosing spondylitis: a population-based study in Southeast Norway

Background ContextIndividuals diagnosed with ankylosing spondylitis (AS) face an increased risk of spine fractures, specifically cervical spine fractures (CS-Fxs). In the past two decades, biological disease-modifying antirheumatic drugs (bDMARDs) have provided considerable relief from pain and an enhanced sense of wellbeing for a large segment of AS patients. Despite these improvements, it remains unclear whether extended use of bDMARDs can indeed reduce the risk of spine fractures. PurposeIn this study, we aimed to investigate the evolving patterns and epidemiology of traumatic CS-Fxs in both AS and non-AS populations. We hypothesized that the risk of CS-Fxs among AS patients would show a decreasing trend over time, while the risk among non-AS patients would remain constant. Study Design/SettingRetrospective cohort study based on a prospective database. Patient SampleA total of 3,598 consecutive patients with CS-Fxs were treated at Oslo University Hospital over an 8-year period. Outcome MeasuresCS-Fxs in AS patients were contrasted with non-AS-related CS-Fxs in terms of temporal trends, age, sex, injury mechanism, associated cervical spinal cord injury (cSCI), need for surgical fixation, and 30-day mortality. MethodsData regarding all CS-Fxs diagnosed between 2015 and 2022 were extracted from the Southeast Norway population-based quality control database for traumatic CS-Fxs. Categorical data were summarized using frequencies, and continuous data were summarized using medians. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-squared test and Fischer exact test were used to compare categorical variables. To investigate the trend in the incidence of fractures, two different Poisson models were fitted with the number of non-AS and AS fractures as dependent variables and the year as the explanatory variable. ResultsOver an 8-year period, we registered 3,622 CS-Fxs in 3598 patients, with AS patients accounting for 125 of these fractures. Relative to their non-AS counterparts, AS patients presented a 9-fold and 8-fold higher risk of initial and subsequent CS-Fxs, respectively. We observed a declining trend in AS-related CS-Fxs with an annual linear decrease of 8.4% (p=.026), whereas non-AS-related CS-Fxs showed an annual linear increase of 3.7% (p<.001). AS patients sustaining CS-Fxs were typically older (median age 70 vs 63 years), predominantly male (89% vs 67%), and more frequently experienced injuries due to falls (82% vs 57%). They also exhibited a higher prevalence of subaxial CS-Fxs (91% vs 62%), fewer C0-C2 CS-Fxs (14% vs 44%), a higher rate of associated cSCI (21% vs 11%), and a greater tendency for surgical fixation (66% vs 21%). We observed a 30-day mortality rate of 11% in AS patients and 5.4% in non-AS patients (p=.005). ConclusionsThe results of this study confirm the elevated risk of CS-Fxs among AS patients, although this risk appears to show a decreasing trend. The most plausible explanation for this risk reduction is the widespread application of bDMARDs

Safety of Docetaxel in a Patient with Metastatic Castration-Resistant Prostate Cancer After Kidney Transplantation: A Case Report

There are limitations in treating advanced prostate cancer (PC), especially castration-resistant (CR) cases, in renal transplant recipients (RTRs). We describe the case of RTR with metastatic CRPC (mCRPC) treated with docetaxel. A 60-year-old man with end-stage renal disease due to autosomal-dominant polycystic kidney disease (ADPKD) underwent living-related kidney transplantation. A year later, he was diagnosed with PC (prostate-specific antigen level: 998 ng/mL). Prostate biopsy revealed prostatic adenocarcinoma with a Gleason score of 4 + 4 = 8. Radiographic examination revealed seminal vesicle invasion and multiple bone and lymph node metastases. Combined androgen blockade therapy was initiated; however, the patient was diagnosed with CRPC 6 months later. Triweekly docetaxel therapy was administered 28 months after diagnosis. The patient successfully completed 7 cycles of this therapy without major adverse events. However, after the 7th cycle, he developed a high fever caused by an infection of ADPKD-associated renal cysts. Therefore, docetaxel was discontinued, and enzalutamide was started, followed by abiraterone, but without any effect. We then introduced cabazitaxel but discontinued it because of hepatic dysfunction. Hence, the patient underwent a docetaxel rechallenge. He was administered the PEGylated form of the recombinant human granulocyte colony-stimulating factor for neutropenia prophylaxis. After 6 cycles of rechallenge docetaxel therapy, the patient accidentally fell, resulting in a cervical spine fracture and subsequent death due to respiratory failure. Docetaxel can be safely delivered to patients with CRPC after renal transplantation who are taking oral immunosuppressants. It can be a good treatment option for them.

Timelines for Return to Different Sports Types After Eight Cervical Spine Fractures in Recreational and Elite Athletes: A Survey of the Association for Collaborative Spine Research.

Prospective cross-sectional survey. To identify timelines for when athletes may be considered safe to return to varying athletic activities after sustaining cervical spine fractures. While acute management and detection of cervical spine fractures have been areas of comprehensive investigation, insight into timelines for when athletes may return to different athletic activities after sustaining such fractures is limited. A web-based survey was administered to members of the Association for Collaborative Spine Research that consisted of surgeon demographic information and questions asking when athletes (recreational vs elite) with one of 8 cervical fractures would be allowed to return to play noncontact, contact, and collision sports treated nonoperatively or operatively. The third part queried whether the decision to return to sports was influenced by the type of fixation or the presence of radiculopathy. Thirty-three responses were included for analysis. For all 8 cervical spine fractures treated nonoperatively and operatively, significantly longer times to return to sports for athletes playing contact or collision sports compared with recreational and elite athletes playing noncontact sports, respectively (P< 0.05), were felt to be more appropriate. Comparing collision sports with contact sports for recreational and elite athletes, similar times for return to sports for nearly all fractures treated nonoperatively or operatively were noted. In the setting of associated radiculopathy, the most common responses for safe return to play were "when only motor deficits resolve completely" and "when both motor and sensory deficits resolve completely." In this survey of spine surgeons from the Association for Collaborative Spine Research, reasonable timeframes for return to play for athletes with 8 different cervical spine fractures treated nonoperatively or operatively varied based on fracture subtype and level of sporting physicality.

Evaluation of preoperative coagulation function changes and deep vein thrombosis incidence in elderly patients with hip fractures.

This study involved an analysis of preoperative deep vein thrombosis (DVT) incidence and changes in coagulation function among elderly patients suffering from hip fractures. The objective was to offer guidance on the prevention and management of preoperative DVT in the lower extremities of elderly individuals with hip fractures. A total of 282 elderly individuals with a hip fracture were enrolled and divided into two groups based on the location of the fracture: femoral intertrochanteric fracture (FIF, 161 individuals) and femoral neck fracture (FNF, 121 individuals). The two groups were compared with respect to baseline characteristics, including gender, age, and comorbid chronic diseases. Furthermore, the analysis encompassed the incidence of preoperative DVT in both lower extremities, along with seven coagulation parameters and platelet count before the surgical procedure. There was no significant difference in baseline information between the two groups. The incidence of preoperative DVT in the FIF group was higher than that in the FNF group, along with a significantly higher percentage of patients exhibiting increased levels of D-dimer and fibrinogen/fibrin degradation products (FDPs). Preoperative hypercoagulability and a greater prevalence of DVT were observed in elderly individuals with FIF compared to individuals with FNF. This indicates that clinicians should pay attention to elderly patients with FIFs, especially those with increased D-dimer and FDP levels.

A comparative study of mortality rate in operated elderly patients of fracture neck of femur, within 90 days of surgery before and during COVID-19 pandemic in the Indian population

Fracture neck of the femur is a significant cause of morbidity and mortality in the elderly and surgical interventions are the preferred treatment. The COVID-19 pandemic caused a reduction in operative cases and emphasized non-operative management. We studied the impact of the COVID-19 pandemic on post-operative 90 days mortality of hip fracture in the elderly Indian population. We, retro-prospectively compared data from our hospital over a two-year time frame on a large group. The first confirmed case in Maharashtra was reported on 9th March 2020 in Pune. The cases reported until one year from this date were termed ‘Covid period’ and cases one year before this date were termed ‘Pre-covid period’. After applying exclusion criteria to 638 patients from 2 years of data, 379 patients(208 in Pre-covid and 171 in Covid period) were included and analyzed for mortality rate and secondary outcomes.The pandemic caused a statistically significant increase in postoperative 90 days mortality in the elderly by 75.7% compared to pre-covid mortality. The decrease in incidence of operated fracture neck femur was non-significant during Covid compared to incidence in pre-covid. Pneumonia caused six times more mortality during Covid period.The COVID-19 pandemic caused a statistically significant increase in postoperative mortality. Pneumonia was the significant cause of death in Covid period and should be diagnosed and treated early. A specific subset of the consent process is a must in elderly neck femur fracture undergoing surgery and shared guidelines of this study will help in the decision-making process of future covid pandemic situations.

Prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall

According to epidemiological studies, the 30% of aged 75 years and older is having impaired vision and most of the cases these patients are not in contact of the hospital care staff and community eye services. The visual assessment of older people is essential and helps to minimize the issues related to fall that led to critical problem. The proper vision is required for regain independence and improve the patient’s overall wellbeing. This kind of situation is leading the individual to unintentional injury which is higher among the visually impaired people compared to fully sighted population. Moreover, there are two major reasons for visual impairment that are more susceptible.The study aims to analyze the prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall at SCB Medical College and Hospital, Cuttack, Odisha.The current study has been conducted at SCB Medical College and Hospital, Cuttack, Odisha. All inpatients of the orthopaedic rehabilitation wards were recuperating from the surgical repair of a fractured neck of femur aged 75 years and above. and all the visual impairment assessed at Ophthalmology OPD. Moreover, the investigator has also invited the patients who sustained their fracture after a simple slip, trip and fall. Apart from this, the mental test of these participants was also done to analyze the ability. In this test the score of seven and above was considered for allowing the patients to take part in the study. There was a full ocular examination of anterior and posterior segment performed by the ophthalmologist using the slit-lamp bio microscope and indirect ophthalmoscope.Visual impairment of criteria 1 sensitivity was 93% and specificity was 91%. Moreover, the likelihood ratio of positive results was 11 and negative result was 0.05. For the criteria 2 the sensitivity was 97% and specificity was 86%. Moreover, the likelihood of positive results was 6 and negative result was 0.02. Apart from this detection of potentially remedial visual impairment sensitivity was 69% and specificity was 91%. The likelihood ratio of positive result was 8 and negative result was 0.2.The vision test and proper ocular examination were underestimated the extent of vision impairment in older adults. As per the outcome of the study, the visual impairment is common in elderly patients with a history of falls. Moreover, the study has suggested that to measure the visual acuity of all elderly patients recuperating from a proximal hip fracture after a simple fall.

Immediate Loaded Post Extraction Implant and Connective Graft-Guided Bone Regeneration: A Case Report

This case report describes the clinical and therapeutic approach used in a 32-year-old female patient with a tooth fracture in tooth 22. The patient, with no history of systemic disease, presented with a chronic periapical lesion and a cervical fracture in the affected tooth. Treatment included atraumatic extraction of the tooth, followed by placement of a 3.75 x 10mm post-extraction implant with immediate loading and guided bone regeneration. The minimally invasive surgical technique was employed using the Dentoflex® drilling sequence. The primary stability of the implant, measured in 37 Newtons of torque, allowed the placement of a prefabricated metal abutment for the subsequent cemented crown. Bone regeneration of the interimplant space was successfully performed, supplemented by connective grafting due to the patient's thin gingival phenotype. Postoperative follow-up, including controls at 7, 14 days and four months, showed a satisfactory conformation of the gingival margin and papillary tissue, consolidating the success of the treatment.

Utility and limitations of postmortem computed tomography in animal abuse suspected cases: A case series study of cats

ObjectivesInjuries caused by animal abuse are termed non-accidental injuries, and should be distinguished from accidental injuries. We compared postmortem computed tomography (PMCT) and necropsy findings in deceased cat bodies suspected of having been abused to determine whether findings previously reported to be associated with abuse or accident could be ascertained by necropsy or PMCT. Materials and methodsSeven deceased cat bodies requested by the police for necropsy because of suspicion of animal abuse were used to compare necropsy and PMCT findings. ResultsPMCT revealed gas distribution abnormalities, such as pneumocephalus and pneumothorax, and bone lesions findings, such as cervical and pelvic fracture; however, several of these were not confirmed at necropsy. Findings such as liver contusion and injury to the posterior vena cava were confirmed only by necropsy and not by PMCT. Findings related to animal abuse, i.e., ocular injuries, skull, bilateral rib, and femoral fractures were confirmed by both PMCT and necropsy in 3, 5, 2, and 2 cats, respectively. Pneumothorax, pelvic fracture, and sacroiliac luxation, related to accidents, were confirmed only by CT in 6 of 6, 1 of 4, and 2 of 2 bodies. ConclusionPMCT revealed gas- and some bone-related findings more efficiently than necropsy, and a combination of PMCT and necropsy is recommended to perform, particularly if the death circumstances is unknown.

Intraradicular reinforcement of traumatized immature anterior teeth after MTA apexification.

This review article describes the methods and clinical recommendations for reinforcing traumatized anterior immature teeth with pulp necrosis treated with mineral trioxide aggregate (MTA) apexification. Traumatic injury can cause pulp necrosis and incomplete root formation in immature teeth. MTA apexification is the treatment of choice for necrotic immature teeth, particularly during the middle or late stages of root development. MTA apexification has a high success rate; however, failures due to cervical or root fractures occasionally occur. The risk of fracture is higher in immature teeth with thin root dentin, particularly those with external root resorption. Furthermore, the loading force from any parafunctional habit also increases fracture risk. Therefore, intra-radicular reinforcement may be necessary after MTA apexification. Invitro, intraradicular restoration with a resin composite/core build-up material or a prefabricated fiber post demonstrated better root reinforcement than root canal obturation materials (i.e., gutta-percha and sealer). However, the root-reinforcement effect of MTA orthograde filling in the entire root canal remains unclear. Invivo, the survival of fractured teeth with intraradicular restorations (resin composite/core build-up material or prefabricated fiber posts) is extremely high. Moreover, the survival of teeth with gutta-percha/sealer obturation or MTA orthograde filling and restoration with resin composite extending into the cervical third of the root canal approximately 1-2 mm below the cemento-enamel junction is acceptably high. Based on this evidence, the remaining tooth/root structure and loading force should be carefully examined when considering intra-radicular reinforcement of immature anterior teeth treated with MTA apexification.

Risk Factors for Blunt Cerebrovascular Injury in a Cohort of Pediatric Patients With Cervical Seat Belt Sign.

Blunt cerebrovascular injury (BVCI), injury to the carotid or vertebral arteries, may result from forces involving seatbelts. Although previous studies have not found a seat belt sign to be a significant predictor for BCVI, it is still used to screen patients for BCVI. This study aims to determine risk factors for BCVI within a cohort of patients with seat belt signs. We conducted a retrospective cohort study using our institutional trauma registry and included patients younger than 18 years with blunt trauma who both had a computed tomography angiography (CTA) of the neck performed and had evidence of a seat belt sign per the medical record. We reported frequencies, proportions, and measures of central tendency and conducted univariate analysis to evaluate factors associated with BCVI. We estimated the magnitude of the effect of each variable associated with the study outcome by conducting logistic regression and reporting odds ratios and 95% confidence intervals. Among all study patients, BCVI injuries were associated with Injury Severity Score higher than 15 ( P = 0.04), cervical spinal fractures ( P = 0.007), or basilar skull fractures ( P = 0.01). We observed higher proportions of children with BCVI when other motorized and other blunt mechanisms were reported as the mechanisms of injury ( P = 0.002) versus motor vehicle collision. Significant risk factors for BCVI in the presence of seat belt sign are: Injury severity score greater than 15, cervical spinal fracture, basilar skull fracture, and the other motorized mechanism of injury, similar to those in all children at risk of BCVI.

ARTICULAR FEMORAL HEAD FRACTURE MANAGEMENT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Femoral head fractures (FHFs) are relatively rare injuries usually caused by high-energy trauma. They typically occur after a posterior dislocation, and approximately 5 to 15 of posterior hip dislocations involve FHFs. FHFs may also occur simultaneously with acetabular fractures, with an estimated incidence of 29.2 In addition, the incidence of ipsilateral femoral head and neck fractures (iFHNF) is low. However, iFHNFs, as a special type of fracture, have the worst prognosis among all FHFs The aim: The aim of this study to show about articular femoral head fracture management. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 17 articles, whereas the results of our search on SagePub get 489 articles, on Google Scholar 8050 articles. Records remove before screening are 5860, so we get 2696 articles fos screening. After we screened based on record exclude, we compiled a total of 12 papers. We included five research that met the criteria. Conclusion: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rates.

Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas

Hanging is one of the most common suicide methods worldwide. Neck injuries that occur upon such neck compression – fractures of the thyrohyoid complex and cervical spine, occupy forensic pathologists for a long time. However, research failed to identify particular patterns of these injuries corresponding to the force distribution a ligature applies to the neck: the issue of reconstructing the knot in a noose position persists. So far, machine learning (ML) models were not utilized to classify knot positions and reconstruct this event. We conducted a single-institutional, retrospective study on 1235 autopsy cases of suicidal hanging, developed several ML models, and assessed their classification performance in a stepwise manner to discriminate between: 1. typical (‘posterior) and atypical (‘anterior’ and ‘lateral’) hangings, 2. anterior and lateral hangings, and 3. left and right lateral hangings. The variable coding was based on the presence/absence of fractures of greater hyoid bone horns (GHH), superior thyroid cartilage horns (STH), and cervical spine. Subject age was considered. The models’ parameters were optimized by the Genetic Algorithm. The accuracy of ML models in the first step was very modest (c. 60%) but increased subsequently: Multilayer Perceptron – Artificial Neural Network and k-Nearest Neighbors performed excellently discriminating between left and right lateral hangings (accuracy 91.8% and 90.6%, respectively). The latter is of great importance for clarifying probable hanging fracture biomechanics. Alongside the conventional inferential statistical analysis we performed, our results further indicate the association of the knot position with ipsilateral GHH and contralateral STH fractures in lateral hangings. Moreover, odds for unilateral GHH fracture, simultaneous GHH and STH fractures, and cervical spine fracture were significantly higher in atypical (‘anterior’ and ‘lateral’) hangings, compared to typical (‘posterior’) hangings.

Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm.

Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.

A minimally invasive fixation for boxers fracture – fifth metacarpal neck using antegrade K wire fixation – functional outcome study

Background: Fifth metacarpal fractures are more common fractures in hand which are treated by conservative or surgical methods. Using retrograde k-wire fixation is associated with more complications due to damage to articular surface causing deformity or decreasing range of motion. Studies are done using single k-wire usage by antegrade technique, results vary due to k-wire complications and surgeon experience. Aims and Objectives: In this study, we are used a technique to bend a K wire in S-shaped fashion to negotiate through fracture to hold and reduce the fracture by rotating the tip of K-wire. Materials and Methods: This prospective study was done for fracture neck of fifth metacarpal presenting to outpatient department in 36 patients with dorsal angulation of more than 300 treated by passing a single k wire bent at the tip and shaft to form an S shape retrogradely with a follow-up period of 6 months following surgery. Results: Majority of injuries were in males in the dominant hand with a mean age group of 27.25 years. The mean pre-operative flexion angle of distal fragment was 44.11° (SD–4.12), and after the end of follow-up healing was achieved in all cases with a mean flexion angle improvement to 5.25° (SD–2.16). Disabilities of the arm, shoulder, and hand score measured at the end of study showed a mean of 6.25, and total active motions core showed excellent results in 25 cases (69.4%) cases and poor in 1 case (2.77%). Conclusion: This study emphasizes that bending a K wire in a lazy S fashion and passing antegradely will replicate results similar to using 2 K wires and have a better prognosis than retrograde wiring through the head of metacarpal. Furthermore, this procedure can be done in a primary care setting with minimal resources.

Cervical Vertebrae Internal Fixation Revision in a Patient with Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that affects the sacroiliac joints and surrounding joints. It is a seronegative spondyloarthritis that invades connective tissue. Managing cervical spine fractures in patients with AS is particularly challenging due to the severity of the deformity and the instability of the fracture. Cervical spine fracture combined with spinal cord injury is the leading cause of death and is strongly correlated with in-hospital mortality in patients with ankylosing spondylitis. There have been limited reports on the revision of cervical spine fractures after internal fixation in patients with AS. The case report is about a patient who is a 34-year-old man who underwent emergency surgery at a local hospital for a cervical spine fracture resulting from a car accident. A postoperative review revealed that the anterior internal fixation was detached, leading to a revision surgery being performed according to the patient&amp;apos;s actual condition. Unfortunately, the internal fixation became dislodged fol-lowing the initial surgery, exacerbating the patient&amp;apos;s condi-tion and leading to the development of pneumonia. In order to prevent the need for revision surgery, it is crucial to carefully evaluate and determine the most suitable surgical approach for patients with cervical spine fractures and spinal cord injury before proceeding with the initial surgery.

Evaluation of Clinical and Radiological Outcomes in the Management of Intracapsular Fracture Neck of Femur in Elderly Treated With Cemented Bipolar Prosthesis.

Hip fractures, including femoral neck fractures (FNFs), represent a significant health challenge globally. Fractures of the hip can be categorized as either intracapsular or extracapsular. Among the elderly, FNFsare particularly prevalent and account for approximately half of all hip fractures. This study aimed to evaluate the clinical and radiological outcomes of intracapsular FNFs in the elderly treated with cemented bipolar prostheses. Objectives: This study aims to: (i) assess the clinical outcomes, including pain relief, functional mobility, and patient satisfaction, in elderly individuals with intracapsular FNFs treated with cemented bipolar prosthesis; (ii) examine the radiological outcomes of intracapsular FNFs in the elderly following treatment with cemented bipolar prosthesis, focusing on factors such as implant stability, fracture healing, and any signs of complications. A prospective study included elderly patients (aged 55 and above) with intracapsular FNFs treated with cemented bipolar prostheses. Data were collected using a structured proforma, and outcomes were assessed through clinical and radiological evaluations at regular follow-ups. The study included 60 participants with a mean age of 65.25 years. Most fractures were subcapital, and the majority of participants did not experience complications after surgery. The average length of the pre-operative hospital stay was 2.35 days, and the post-operative hospital stay was 6.75 days. Functional outcomes, evaluated using the Harris Hip Scoring System, showed varying degrees, with 70% of participants experiencing good outcomes. The management of intracapsular femoral neck fractures in the elderly with cemented bipolar prostheses demonstrated favorable outcomes, including low morbidity, simple operative procedures, and satisfactory early functional results. The study supports the recommendation of cemented bipolar prostheses for femoral neck fractures in individuals over 60, emphasizing their superiority over bipolar hemiarthroplasty. The results contribute valuable insights for treatment decisions in hip fractures, especially considering evolving reimbursement mechanisms and merit-based incentive payments.

T1 Pedicle Subtraction Osteotomy With Subaxial Cervical Pedicle Screw Fixation.

Patients suffering from ankylosing spondylitis are not only predisposed to the development of rigid cervicothoracic deformities but are also at an increased risk of cervical fractures. Deformity correction and stabilization are particularly challenging in this patient population due to the brittle bone quality and low bone mineral density. Thoracic pedicle subtraction osteotomy is a workhorse approach for the correction of focal severe kyphotic deformity with lower complication rates than 3-column osteotomy. Successful execution of an upper thoracic PSO requires careful presurgical planning as well as anticipation of the patient's postoperative needs. Here, we describe the use of a T1 PSO in the correction of a rigid cervicothoracic chin-on-chest deformity in a patient with AS. The risk of implant failure was reduced by the use of a multi-rod construct, navigated cervical pedicle screws, and dual-pitched thoracic pedicle screws.

Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings.

Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns. This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis. Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall. Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.

Endotracheal Intubation without Neuromuscular Blocking Agent in Patient with Fracture Cervical Spine C1 and C4 Underwent Fusion C1–2 and C4–6

About 30% of cervical spine fractures involve injuries to the C1 and C2 vertebrae, which are considered unstable. Ensuring the stability of the injured cervical spine throughout perioperative period, including preoperative examinations, anesthesia induction, laryngoscopy, and intubation, is crucial for anesthesiologists. A 40-year-old woman suffered neck pain following a motorcycle accident, suffering a Spinal Cord Injury ASIA Impairment Scale (SCI AIS) E, a fracture of the C5 vertebral body (CV) classified as AO Spine Type A2, a Jefferson Type IV fracture, and mild head trauma. She underwent surgical fusion of the C1–C2 and C4–C6 vertebrae under general anesthesia, which included dexmedetomidine, propofol, sevoflurane, and fentanyl without any neuromuscular blocking agents (NMBA). The primary goal of perioperative airway management in cervical injury is a secured airway, while maintaining cervical stability without inflicting secondary injury. The cervical muscle group is essential for maintaining cervical stability, and the use of NMBA may jeopardize this stability, necessitating external cervical stabilization, especially during laryngoscopy and intubation. Induction agents in combination with opioid, widely used to facilitate laryngoscopy and intubation without using NMBA. Anesthesiologists must precisely arrange the management of cervical spine injuries patient to avoid secondary injury and improve surgical outcomes

Demographics in the context of health-care delivery for C1 and C2 fractures.

Atlas and axis fractures are the most severe cervical fractures which may result in complete paralysis or death. The purpose of the current study is to identify disparities regarding length of stay (LOS), mortality, and demographic factors in patients with the most serious cervical spine fractures utilizing a nationally representative database. The Nationwide Emergency Department Sample was utilized to provide a representative sample for patients with a primary diagnosis of C1 or C2 fracture presenting to emergency departments in years from October 2015 to December 2019. A multivariable logistic regression model was used to estimate LOS for different patient demographics, including gender, race, and age. A weighted sample of 7,262,791 patients presented to emergency rooms in the United States between 2015 and 2019. The mean age at admission was 76 years old, 52.6% of patients were female, and 83.0% identified as white. Patients between 45 and 65 and patients over 65 were significantly more likely to have an increased LOS. Women were less likely to have an increased LOS than men. Patients identifying as Black were significantly more likely to have increased LOS over white patients. In addition, patients who had an increased LOS were more likely to die in the hospital than patients with a shorter LOS. This study provides patient characteristics that help providers determine patient risk factors for increased hospital LOS and in-hospital mortality for those suffering from C1 and C2 fractures. Clinicians should be made aware of these disparities to allow equitable delivery of care.