Common Mechanism Of Trauma Research Articles

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register

BackgroundDue to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment. MethodsThe study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis. ResultsThe study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures. ConclusionCalcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically. Level of evidenceIV, retrospective observational cohort study

Characteristics and Therapy of Jersey Finger Type V Injuries at a Middle-European Level 1 Trauma Center-A Retrospective Data Analysis.

Background/Objectives: Reports on type V FDP tendon avulsions and their treatment are rare. Furthermore, they are not always classified in a consistent manner in the literature. The purpose of our retrospective data analysis was to evaluate and present jersey finger type V injury characteristics, primary radiological findings, treatment options and subsequent patient outcomes, as well as potential complications. Methods: We reviewed all patients treated for a fracture of the distal phalanx at an academic Level 1 trauma center over a period of 19 years. By reviewing the patients' charts and their initial X-rays, we identified 44 patients with injuries matching the criteria for classification as jersey finger type Va and type Vb. All clinical records and radiologic images were reviewed to gather data on the mechanism of trauma, injury characteristics, type of treatment and subsequent outcomes in both subtypes. Results: Direct blows represented the most common mechanism of trauma, accounting for 23 cases. Among 44 jersey finger type V injuries, 31 showed minor displacement and were treated conservatively with a good outcome. Six patients undergoing surgery showed a poor outcome, except for one. Conclusions: Jersey finger type V differs considerably from the remaining types of jersey finger injuries regarding the predominant trauma mechanism. Therefore, its inclusion in this classification should be reevaluated. Established surgical techniques for refixation did not show a satisfying outcome, thus the implementation of alternative surgical techniques seems advisable when better therapeutic results are sought.

Prevalence and clinical outcomes of acute myocardial infarction in patients presenting with major trauma

BackgroundThe occurrence and sequelae of acute myocardial infarction (AMI) in major trauma patients is underexplored across both trauma and cardiology specialties. Coronary reperfusion greatly reduces the risk of significant morbidity and mortality in AMI. However, in patients presenting with significant injuries, concurrent AMI presents a competing management priority given the increase in risk of bleeding with standard anticoagulation and antiplatelet therapy, which may be contraindicated. This study aimed to evaluate the epidemiology and clinical outcomes associated with AMI in a contemporary major trauma cohort. MethodsThis study used data from the Victorian State Trauma Registry (VSTR). All adult patients with major trauma from 1 January 2013 to 31 December 2022 were included. Patients that died prior to hospital arrival were excluded. AMI was identified by ICD-10-AM diagnosis codes recorded against the first hospital admission. Clinical outcomes included in-hospital mortality, length of stay, and discharge destination. Results28,928 patients were identified over the 10-year study period. AMI occurred in 401 patients (1.4 %). AMI patients were older, had more comorbidities and were more frequently on anticoagulation or antiplatelet therapy. Low impact fall was the most common trauma mechanism in AMI patients. Patients with AMI experienced longer hospital stays (12 [7–20] versus 7 [4–12] days, p < 0.001) and higher rates of in-hospital mortality (adjusted RR 1.45, 95 % CI 1.25–1.65). ConclusionAMI in the setting of major trauma occurs in an older, more comorbid, and vulnerable group of patients. AMI is associated with an increased risk of in-hospital mortality and prolonged hospital stay in the setting of major trauma, underscoring the importance of identifying and treating major trauma associated AMI in a timely and effective manner.

Rib Fractures in Trauma Patients: Prevalence, Associated Injuries, and Mortality Trends.

Introduction Rib fractures are a common consequence of thoracic trauma, often signaling the presence of additional injuries and increasing the risk of mortality. This study aimed to elucidate the frequency, patterns, and mortality rates associated with rib fractures in multitrauma patients and to explore the association between rib fractures and other systemic injuries. Methods In a retrospective observational study at a tertiary care hospital, electronic medical records of multi-trauma patients over a four-year period were examined. Inclusion criteria encompassed adult patients who had undergone whole-body or chest and abdomen CT imaging. The study evaluated the incidence and location of rib fractures, associated thoracic and intra-abdominal injuries, and the in-hospital mortality rate. Results Among the 1,338 patients analyzed, rib fractures were identified in 273 (20.4%), with a median age of 33 years and 199 (72.9%) were male. Motor vehicle accidents were the most common trauma mechanism with a rate of 52% (n=142). Patients with rib fractures had significantly higher occurrences of pneumothorax (25.3%), hemothorax (20.9%), and intra-abdominal injuries (17.5%) (p<0.001). Notably, patients with six or more rib fractures exhibited a higher frequency of liver, spleen, and kidney injuries (p=0.003, p=0.011, p=0.001, respectively). The in-hospital mortality rate was 5.9% (n=17) for patients with rib fractures, significantly higher than those without (p<0.001). Conclusion Rib fractures in multi-trauma patients are an important indicator of severe concurrent injuries and are associated with a higher mortality rate. These findings advocate for a systemic and immediate evaluation of patients with rib fractures upon presentation in emergency departments to improve survival outcomes.

Evaluation of traumatic spinal injuries: a pediatric perspective.

The aim of the present study is to provide information about pediatric patients with spinal trauma. A single-center retrospective chart review was carried out. Children who arrived at the pediatric emergency department due to trauma and those with spinal pathology confirmed by radiological assessment were included. Demographics, mechanisms of trauma, clinical findings, radiological investigations, applied treatments, hospital stay and prognosis were recorded. A total of 105 patients [59 (56.2%) boys; mean age: 12.9 ± 3.8years (mean ± SD)] were included. The most common age group was that of 14-18years (58.1%). The three most common trauma mechanisms were road traffic collisions (RTCs) (60.0%), falls (32.4%), and diving into water (2.9%). A fracture of the spine was detected in 97.1% patients, vertebral dislocation in 10.7%, and spinal cord injury in 16.3%. Of the patients, 36.9% were admitted to the ward and 18.4% to the pediatric intensive care unit; 17.1% were discharged with severe complications and 2.9% cases resulted in death. While 34.3% of the patients had a clinically isolated spine injury, the remaining cases entailed an injury to at least one other body part; the most common associated injuries were to the head (39.8%), abdomen (36.1%), and external areas (28.0%). Spinal trauma was found to have occurred mostly in adolescent males, and the majority of those cases were due to RTCs. Data on the incidence and demographic factors of pediatric spinal trauma are crucial in furthering preventive measures, allowing for the identification of at-risk populations and treatment modalities.

Orthopaedic and trauma research in Tanzania: A scoping review.

Tanzania is disproportionately burdened by musculoskeletal injuries as it faces unique challenges when dealing with trauma care. This scoping review aims to summarize and assess the current state of orthopaedic and trauma research in Tanzania. By identifying key themes, trends, and gaps in the literature, this review seeks to guide future research initiatives catered specifically to the needs of Tanzania's healthcare system. Utilizing the PRISMA-ScR protocol, OVID Medline, PubMed, and CINAHL databases were searched from inception to June 17, 2023, using keywords such as "Orthopaedics" "Trauma" and "Tanzania". One hundred and ninety-two eligible studies were included and the Arksey and O'Malley framework for scoping studies was followed. There was a notable growth of relevant publications from 2015 onward, with peaks in growth in the years 2019, 2021, and 2020. The studies employed diverse research methodologies, with cross-sectional (n = 41, 21%) and prospective studies (n = 39, 20%) being the most prevalent, and randomized-controlled trials being the least prevalent methodology, making up eight studies (4.2%). The most common study themes were trauma (n = 101, 52.6%), lower extremity (n = 31, 16%), and spine-related issues (n = 27, 14%). Only three studies looked at work-related injuries (1.6%). Road traffic injuries (RTIs) were the most common mechanism of trauma in 77.0% of the trauma focused studies. Fifty-three percent of the studies were conducted by a majority of Tanzanian authors. This scoping review highlights various trends in orthopaedic and trauma research in Tanzania, with a particular emphasis on road traffic-related injuries. Various gaps are explored, including a lack of research on work-related injuries and a paucity of experimental research. Our findings underline areas where future research is warranted. The future of orthopaedic and trauma care in Tanzania depends on the efforts and collaboration of both local and international stakeholders.

Increased incidence of traumatic spinal injury in patients aged 65 years and older in the Netherlands

PurposeThe global population is ageing rapidly. As a result, an increasing number of older patients with traumatic spine injuries are seen in hospitals worldwide. However, it is unknown how the incidence of traumatic spinal injury has developed over the past decade. Therefore, this study aimed to determine the incidence and characteristics of traumatic spinal injury in patients aged under and above 65 years.MethodsDuring three time periods: 2009–2010, 2014–2015 and 2019–2020, all adult patients with traumatic spinal injury in the Netherlands were identified from the Dutch National Trauma Registry. Patient-related characteristics and 1-year mortality were collected from a subgroup of patients treated at a level-1 trauma centre, and patients aged ≥ 65 years were compared to patients aged < 65 years.ResultsIn the Dutch National Trauma Registry 25,737 patients with traumatic spinal injury were identified. The incidence of spine injury in patients > 65 years was 49.5/100,000/yr in 2009–2010, 68.8 in 2014–2015 and 65.9 in 2019–2020. The percentage of patients ≥ 65 years increased from 37% in 2009–2010, to 43% in 2014–2015, and to 47% in 2019–2020. In the subgroup of 1054 patients treated in a level-1 trauma centre, a similar increasing incidence was seen in patients aged ≥ 65 years. In these patients low energy falls were the most common trauma mechanism and the cervical spine was the most commonly injured region. Moreover, patients ≥ 65 years had significantly higher 1-year mortality compared with patients aged < 65 years, 22.7% versus 9.2%.ConclusionThe incidence of traumatic spinal injury in older patients in the Netherlands has increased over the last 12 years. Almost half of the patients with traumatic spinal injury are currently aged ≥ 65 years. The increasing incidence and the high 1-year mortality highlight the need to modify existing treatment protocols for these patients.

A survey on occupational injuries and related factors among emergency patients of Mashhad teaching hospitals over a year.

Occupational injuries (OI) are a - significant source of social and economic costs. They can cause prolonged absences from work, loss of limb, and worker disability, among other negative consequences. In light of this, the present study aimed to evaluate the factors associated with OI in trauma centers affiliated with Mashhad University of Medical Sciences. This cross-sectional study was carried out among patients admitted to the trauma ward of four teaching hospitals in Mashhad during 2019-2020. Patients' data was collected in a checklist and trauma severity was assessed based on injury severity score. The Epworth questionnaire was completed for patients. Data was analyzed by SPSS 20.0. Out of a total of 13660 patients who were referred to the emergency department of four hospitals of Mashhad University of Medical Sciences, 683 (5.15%) individuals suffered occupational trauma and entered the study. The mean (±SD) age and work experience of the participants were 34 (±10) and 10 (±9) respectively. Most of the participants were in the age group of 20-40 years. the most common mechanism of trauma was falling (p=0.00) and the most injury frequency was among manual working (p=0.01). There was not a significant association between trauma severity and demographic characteristics. Those who had falling or electric accidents had more severe trauma compared to other injured patients. (p=0.00) CONCLUSIONS: In general, the most burden of occupational accidents and in fact, the most serious injuries were related to men and manual workers. Also, most of the injuries happened through falls and cuts. The results of this study showed the need for serious policies to reduce occupational injuries.

Implementation of a pediatric trauma registry at a national referral center in Kenya: Utility and concern for sustainability

BackgroundPediatric trauma disproportionately affects low- and middle-income countries, particularly the pediatric trauma systems, are frequently limited. This study assessed the patterns of pediatric traumatic injuries and treatment at the only free-standing public children's hospital in East Africa as well as the implementation and sustainability of the trauma registry. MethodsA prospective pediatric trauma registry was established at Shoe4Africa Children's Hospital (S4A) in Eldoret, Kenya. All trauma patients over a six-month period were enrolled. Descriptive analyses were completed via SAS 9.4 to uncover patterns of demographics, trauma mechanisms and injuries, as well as outcomes. Implementation was assessed using the RE-AIM framework. ResultsThe 425 patients had a median age of 5.14 years (IQR 2.4, 8.7). Average time to care was 267.5 min (IQR 134.0, 625.0). The most common pediatric trauma mechanisms were falls (32.7 %) and burns (17.7 %), but when stratified by age group, toddlers had a higher risk of sustaining injuries from burns and poisonings. Over half (56.2 %) required an operation during the hospitalization. Overall, implementation of the registry was limited by the clinical burden and inadequate personnel. Sustainability of the registry was limited by finances. ConclusionsThis is the first study to describe the trauma epidemiology from a Kenyan public pediatric hospital. Maintenance of the trauma registry failed due to cost. Streamlining global surgery efforts through implementation science may allow easier development of trauma registries to then identify modifiable risk factors to prevent trauma and long-term outcomes to understand associated disability.

Anterior Cruciate Ligament Reconstruction in Tibial Eminence Avulsion Fracture: A Case Series

Introduction: Ruptures of the anterior cruciate ligament (ACL) are common orthopedic injuries, especially among patients participating in sports. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. This article describes several cases of ACL rupture management with eminence avulsion. Case report: This case series describes 3 cases of ACL tear with eminence avulsion. The first patient was a 31-year-old female with right knee pain since 6 months ago after a traumatic fall from a motorcycle. The second patient, a 16-year-old girl with a history of bending her legs inward during exercise. The third patient is a 49-year-old female with a history of accidents and complaints of knee pain. All three patients found ACL tear accompanied by an avulsion fracture on the tibial eminence and then undergo ACL reconstruction. Discussion: The most common mechanism of trauma, which leads to a disruption of ACL, is a trauma forcing the knee in hyperextension combined with valgus-external rotation. At times, these lesions can occur in adults; in this instance, the main cause is high-energy trauma, such as road accidents. Based on case reports and previous research, the management approach in this case is still debatable in children and adults and requires a specific approach in each case. Conclusion: The management of ACL reconstruction in patients with tibial eminence avulsion involvement is still a challenge for orthopedic surgeon. Given the rarer cases, a different approach is needed in young and adult cases. Each case requires proper management to improve the patient's functional outcome and their quality of life. Keywords: anterior cruciate ligament reconstruction, avulsion fracture, tibial eminence avulsion

Vertebral Fracture and Its Outcomes in Emergency Patients of Kowsar Hospital in Sanandaj: An Epidemiological Study

Background: Vertebral fracture, one of the most incidents in human life, is associated with many complications. Due to the importance of this complication, this study was conducted to epidemiologically investigate vertebral fractures and their consequences in the emergency department of Kowsar Hospital in Sanandaj in 2017. Methods: In this retrospective cross-sectional study, 350 patients who visited the emergency department of Kowsar Sanandaj Hospital in 2017 due to vertebral fractures were included. The data was extracted from information collected through phone contact and patients’ medical documents. V Kramer and ETA tests were performed to analyze the hypotheses using SPSS 25 software. Results: Men constituted 61% of the patients. The average age of the patients was 42.18 (6.86) years, and almost 41% of the patients lived in Sanandaj. The most common trauma mechanism was fall injury with 44.8%, 59.55% of which were in the lumbar region. Compression and burst fractures had the highest fracture rates with 47.85 and 21.9 percent, respectively. Conclusion: According to the findings, the fractures were more prevalent in men, young people, and in labor and agricultural occupations, and there is a significant relationship between the consequences of fractures with age, sex, and occupation, which indicates the need for more safety considerations in these people. Therefore, it is necessary to identify and subsequently modulate the risk factors associated with falling injuries to reduce this type of injury.

Evaluating the Utility of Repeat Computed Tomography Scans in Patients with Isolated Mild Traumatic Subarachnoid Hemorrhage

Background and ObjectivesTraumatic subarachnoid hemorrhage (tSAH) is a common consequence of head trauma. Treatment of tSAH patients commonly involves serial CT imaging to assess for expansile hemorrhage. However, growing evidence suggests that these patients rarely deteriorate or require neurosurgical intervention. We assessed the utility of repeat CT imaging in adult patients with isolated tSAH and an intact initial neurologic exam. MethodsPatients presenting to Mass General Brigham Hospitals with tSAH between 2000 and 2021 were eligible for inclusion in this retrospective cohort study. Patients were excluded if their SAH was non-traumatic, they experienced another form of intracerebral hemorrhage, or if they had a documented Glasgow Coma Score (GCS) of 12 or lower and/or poor presenting neurological exam. Univariate and multivariate regression models were used for statistical analysis. ResultsOverall, 405 patients were included (191 male). The most common mechanism of trauma was fall from standing (58%). The mean number of total CTs for all patients was 2.3, with 329 patients (80%) receiving two or more. 309 patients presented with no significant neurological symptoms. No patients developed acute neurologic deterioration or required neurosurgical intervention related to their bleed, although five had mild hemorrhagic expansion on follow up imaging. ConclusionIn the present study, repeat imaging rarely demonstrated meaningful hemorrhagic expansion in this cohort of neurologically intact patients with isolated tSAH. In these patients with mild TBI, excessive CT imaging is perhaps unlikely to affect patient management and may present unnecessary burden to patients and hospital systems.

Spectrum, Pattern and Outcome of Trauma patients admitted to Tertiary care hospital in North India

Introduction: Trauma is foremost reason behind the mortality and morbidity worldwide among all age groups. Trauma remains the vital public health issues worldwide and is independent of socioeconomic condition of a country. Incidence of trauma is still increasing with increase in incidence of violence, road traffic accident, assault and violence. Trauma will still remain if all medical and surgical diseases are overcome. Aims and Objectives: The aims and objective of our study was to evaluate the spectrum, pattern, mechanism and outcome of trauma patient presenting at tertiary care hospital. Results: Trauma patient visited to tertiary care hospital were 1926 (with 73% male and 27% female). Most common age group was 21-30 years. Most common mechanism of trauma was RTA which include 60% patient followed by fall. Most common site of injury was extremities followed by head and neck injuries. 28% of trauma patient were hospitalized. 66% of hospitalized patients were managed conservatively while 34% of the were managed surgically. 92% of the trauma patients were survived while mortality was only 8%. Conclusions: RTA is most common form of trauma affecting most commonly young male in their third decade of life. Health education and behaviour change among the youngster about trauma may reduce the trauma injuries.

TREATMENT OF PEDIATRIC FEMUR FRACTURES WITH FLEXIBLE STAINLESS STEEL INTRAMEDULLARY NAIL.

To identify the characteristics of patients and femur fractures treated with a stainless steel intramedullary nail (ESIN) in children under 15 years of age. Know the results of using the ESIN of related steel in the service. Retrospective study with review of hospital records and organization of data in spreadsheets. 24 cases were identified, 17 male cases and 7 female cases. A minimum age of 4 years and a maximum of 11 years were observed (average of 7 years). The 3 most common trauma mechanisms were being run over (n:8, 33%) and falling from a height (n:8, 3%). The most common location of the fractures was in the mid-diaphyseal region (n: 20, 88%), only one case presented a bilateral femur fracture. The most common associated trauma was traumatic brain injury. The observation period observed several months between 2 and 5. With regard to complications, 3 cases were observed (12.5%) being bursitis, vicious construction and loss of reduction. Steel HIF shows similar good results. As the study includes the retrospective profile, the absence of a group and the small sample size. Level of Evidence IV, Case series.

Clinical importance in the early identification of non-accidental trauma in pediatric population: A comparative study among patients of a high – Complexity reference hospital

AimTo compare the pediatric population that presented with accidental and non-accidental abdominal trauma treated in a reference hospital in Bogotá, Colombia. MethodsComparative retrospective case series study of children who presented with accidental abdominal trauma (AT) and non-accidental abdominal trauma (NAT) was carried out. The children were treated at HOMI Fundación Hospital Pediatrico la Misericordia from June 2013 to December 2019. Statistical analysis was performed calculating measures of central tendency and dispersion. ResultsThe study included 175 patients. There was no gender predilection. The most common trauma mechanism in AT was fall (35.17 %) and in NAT was physical aggression (40 %). No difference was found in the dispersion of the Injury Severity Score (ISS). The requirement for surgical approach was higher in the NAT group (63.33 % vs 25.52 %). This group presented with a greater involvement of intra-abdominal organs (75 % vs 52.95 %), greater involvement of the small (20 %) and large (20 %) intestines. NAT children also had more multiple intra-abdominal organs involved (25 % vs 11.76 %), longer intensive care unit stay (56.67 % vs 39.31 %), prolonged hospital stay (7.5 days vs 4 days), and higher complications and mortality (6.67 % vs 2.07 %). ConclusionsNon-accidental abdominal trauma has greater morbidity and mortality in children compared to accidental trauma. For this reason, early identification of these cases is important in order to prevent future complications.

Epidemiology and outcomes of geriatric trauma patients consulting at the center hospitalier universitaire de Kigali emergency department

BackgroundLife expectancy in low- and middle-income countries (LMIC) continues to rise, resulting in a growing geriatric population. In Rwanda, a sub-Saharan LMIC, traumatic injuries are a common cause of mortality and morbidity. However, little is known about the frequency and type of traumatic injuries among geriatric populations in Rwanda. ObjectiveWe explored the epidemiology and outcomes of trauma for geriatric patients presenting to the emergency department (ED) of the center Hospitalier Universitaire de Kigali (CHUK) in Rwanda. MethodsThis prospective cross-sectional study was conducted from July 2019 to January 2020 at the ED of CHUK. Trauma patients aged 65 and above and alive at the time of evaluation were eligible for inclusion. Demographic characteristics were collected along with triage category, mechanism of injury, transfer status, transport method to CHUK, time spent at the ED, complications, and mortality predictors. ResultsFor the 100 patients enrolled, the most common injury mechanism was falls (63%), followed by road traffic accidents (28%). The majority of patients spent less than 48 h in the ED (63%). The mortality rate was 14%, with most deaths resulting from injury-related complications. Triage category, Kampala Trauma Score, and Glasgow Coma Scale were significant predictors of mortality, with p-values of 0.002, <0.001, and <0.001, respectively. ConclusionsThe epidemiology of geriatric trauma found in this study can inform public health and clinical guidelines. Interventions targeting falls and road traffic accidents would target the most common geriatric trauma mechanisms, and clinical protocols that take into account predictors of mortality could improve outcomes and increase life expectancy for this population.

Post-traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH)

ObjectivesTo determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH).Materials and methodsA retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports.ResultsOf 70 post-traumatic patients (54 men, median age 73, IQR 66–81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI.ConclusionsSEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression.Clinical relevance statementLow-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation.Key Points• Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH.• Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma.• Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.

Trauma mechanisms and patterns of blunt cervical vascular injury: A descriptive study using a nationwide trauma registry

ObjectiveBlunt cervical vascular injury (BCVI) is a non-penetrating trauma to the carotid and/or vertebral vessels following a direct injury to the neck or by the shearing of the cervical vessels. Despite its potentially life-threatening nature, important clinical features of BCVI such as typical patterns of co-occurring injuries for each trauma mechanism are not well known. To address this knowledge gap, we described the characteristics of patients with BCVI to identify the pattern of co-occurring injuries by common trauma mechanisms. MethodsThis is a descriptive study using a Japanese nationwide trauma registry from 2004 through 2019. We included patients aged ≥13 years presenting to the emergency department (ED) with BCVI, defined as a blunt trauma to any of the following vessels: common/internal carotid artery, external carotid artery, vertebral artery, external jugular vein, and internal jugular vein. We delineated characteristics of each BCVI classified according to three damaged vessels (common/internal carotid artery, vertebral artery, and others). In addition, we applied network analysis to unravel patterns of co-occurring injuries among patients with BCVI by four common trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height). ResultsAmong 311,692 patients who visited the ED for blunt trauma, 454 (0.1%) patients had BCVI. Patients with common/internal carotid artery injuries presented to the ED with severe symptoms (e.g., the median Glasgow Coma Scale was 7) and had high in-hospital mortality (45%), while patients with vertebral artery injuries presented with relatively stable vital signs. Network analysis showed that head-vertebral-cervical spine injuries were common across four trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height), with co-occurring injuries of the cervical spine and vertebral artery being the most common injuries due to falls. In addition, common/internal carotid artery injuries were associated with thoracic and abdominal injuries in patients with car accidents. ConclusionsBased on analyses of a nationwide trauma registry, we found that patients with BCVI had distinct patterns of co-occurring injuries by four trauma mechanisms. Our observations provide an important basis for the initial assessment of blunt trauma and could support the management of BCVI.

Prevalence of Subdural and Epidural Hematoma in Head Trauma Patients: A Cross-sectional Study

Background: Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department. Materials and Methods: This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files. Results: The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028). Conclusion: The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.

Lateral Humeral Condyle Fractures in Pediatric Patients.

Lateral humeral condyle fractures are frequently seen in pediatric patients and have a high risk of unfavorable outcomes. A fall on the outstretched arm with supination of the forearm is the most common trauma mechanism. A physical examination combined with additional imaging will confirm the diagnosis. Several classifications have been described to categorize these fractures based on location and comminution. Treatment options depend on the severity of the fracture and consist of immobilization in a cast, closed reduction with percutaneous fixation, and open reduction with fixation. These fractures can lead to notable complications such as lateral condyle overgrowth, surgical site infection, pin tract infections, stiffness resulting in decreased range of motion, cubitus valgus deformities, 'fishtail' deformities, malunion, non-union, avascular necrosis, and premature epiphyseal fusion. Adequate follow-up is therefore warranted.