Complete Injury Research Articles

Sex Differences in Blunt Traumatic Aortic Injury from the Aortic Trauma Foundation Global Registry

Trauma is the leading cause of death in people younger than 45 years, and blunt traumatic aortic injury (BTAI) is the second leading cause of death after blunt trauma. There have been reports on variations in physiological response to trauma between men and women, as well as sex/gender disparities in aortic disease outcomes, but there is a gap in the literature on sex differences in patients with traumatic aortic injury. The Aortic Trauma Foundation international prospective multicenter registry was used to examine sex differences in traumatic aortic injury characteristics, management, and outcomes from 2016 to 2022. Data were analyzed by contingency table, stratified and multivariable regression. There were 781 patients with BTAI and complete injury grade information, of whom 182 patients (23%) were female. The mean age was 43.4 ± 18 years, and women were significantly older than men (48 ± 18.6 vs 42.3 ± 17.6 years, P < .0001). A total of 464 patients (59%) underwent thoracic endovascular aortic repair with no significant difference between men (61%, 364 of 599) and women (55%, 100 of 182). Injury severity score and Glasgow coma scores did not differ between women and men. Women more often had pelvic fracture (41% vs 30%, P < .004), splenic injury (31% vs 23%, P < .05), renal injury (22% vs 14%, P < .02), sacral spine fracture (12% vs 6%, P < .02), and sternal fracture (17% vs 10%, P < .02), but these injury patterns were not associated with higher grade aortic injuries. There were no sex differences in the distribution of aortic injury grade. In-hospital mortality was 12%, and aortic-related mortality was 4% for the entire cohort, with no differences between men and women. The presence of sternal fracture appeared to predict higher aortic mortality in women (10% with sternal fracture vs 2% without, P = .05) but not in men (9% with sternal fracture vs 10% without P = .9). There is no difference in mortality between men and women with BTAI. Women with BTAI presented more frequently with intra-abdominal and pelvic injuries, and sternal fractures appear to predict a higher mortality in women with BTAI.

Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors

Spinal cord injuries typically result in a range of negative health outcomes and health states, which impacts overall functioning, health and well-being. It remains important to establish the prevalence (burden) of health outcomes to help with the development of optimal treatment strategies. To determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term spinal cord injury (SCI) receiving public compared with private healthcare services in South Africa. A cross-sectional survey included 200 community-dwelling persons with long-term SCI, 60% with paraplegia, 53% with complete injuries and 156 from the public and 44 from private healthcare sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: (i) demographic and injury characteristics; (ii) SHCs and treatment rates; and (iii) vitality and emotional well-being. All statistical analyses were stratified according to healthcare sector. Pain (47% v. 57), sexual dysfunction (59% v. 41%) and muscle spasms (54% v. 43%) were the most common SHCs in both cohorts, and the period prevalence was significantly higher for sleeping problems (41% v. 25%), sexual dysfunction (59% v. 41%) and contractures (42% v. 20%) in the public compared with the private cohort. Persons with SCI in the private cohort received treatment more often for sleeping problems (100% v. 45%), autonomic dysreflexia (75% v. 27%) and pain (56% v. 33%) than their counterparts with public insurance. Negative mental health states were prevalent in both groups. SHCs and negative mental health were common in persons with SCI in South Africa, while those with public insurance reporter a higher occurrence of sleep problems and contractures, as well as lower treatment rates. Overall, a need exists to better support persons with SCI in the long-term context to facilitate improved functioning and wellbeing.

Preconditions for the Successful Segmental Step-Wise Reconstruction of the Global Function of the Upper Extremity in Case of the Complete Brachial Plexus Injury (Case Report)

Background. The prognosis of recovery of the distal muscles (dM) of the upper extremity (UE) in complete brachial plexus injuries (cBPI) after any selective nerve transfer (NT) is poor. Free functioning muscle transfer (FFMT) is deprived of the disadvantages of NT. By combining NT and FFMT one can achieve recovery of the global functionality of UE in cBPI.&#x0D; Objective: to define theoretical and clinical preconditions for each stage (S) of the segmental reconstruction of UE in cBPI.&#x0D; Materials and Methods. 38 years old male patient 3 months after cBPI underwent NT (S1) of the phrenic to musculocutaneous nerve; branches of the spinal accessory nerve were transferred to axillary and suprascapular nerves. 36 months after S1 the patient underwent wrist (WA) and trapeziometacarpal arthrodesis (TMCA) (S2). 43 months after S1 the patient underwent FFMT of the gracilis muscle (S3). Clinical and neurological, electroneuromyographic (EMG), and X-ray examinations were carried out within the expected time to achieve the expected result after the corresponding stages of reconstruction. Results. 26 months after S1 m. biceps brachii and m. deltoideus recovered to M4; m. supra-infraspinatus ineffectively recovered to M3. A stable arthrodesis effect in WA and TMCA was achieved after 42 months in general. Poor clinical and EMG recovery of the gracilis muscle (S3) within the expected time led to indefinite postponement of S4, with clinical and EMG control every 3 months.&#x0D; Conclusions. Clinical signs of functional recovery cannot be a prerequisite for using a primary recipient nerve as a secondary donor nerve; the number of motor fibers in the donor nerve must be confirmed by objective data of morphometric and histochemical express methods; theoretical preconditions of the “sitting donor” technique appear to be the most promising in terms of recovery of dM of UE.

Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons.

International survey. C5 palsy (C5P) is a neurological complication affecting 5-10% of patients after cervical decompression surgery. Most cases improve with conservative treatment; however, nearly 20% of patients may be left with residual deficits. Guidelines are lacking on C5P management and timing of surgical intervention. Therefore, we sought to survey peripheral nerve surgeons on their management of C5P. An online survey was distributed centered around a patient with C5P after posterior cervical decompression and fusion. Questions included surgeon demographics, diagnostic modalities, and timing and choice of operation. Responses were summarized and the chi-squared and Kruskal-Wallis H tests were used to examine differences across specialties. A total of 154 surgeons responded to the survey, of which 59 (38%) indicated that they manage C5P cases. Average time prior to operating was 4.5 ± 2.2months for complete injuries and 6.6 ± 3.2months for partial injuries, with neurosurgeons significantly more likely to wait longer periods for complete (P = .01) and partial injuries (P = .03). Foraminotomies were selected by 19% of surgeons, while 92% selected nerve transfers. Transfer of the ulnar nerve to the musculocutaneous nerve was the most common choice (81%), followed by transfer of the radial nerve to the axillary nerve (58%). Consensus exists among peripheral nerve surgeons on the use of nerve transfers for surgical treatment in cases with severe motor weakness failing to improve. Most surgeons advocate for early intervention in complete injuries. Disagreement concerns the type of nerve transfer employed, timing of surgery, and efficacy of foraminotomy.

Clinical Profile and Predictors of Early Outcome in Patients with Traumatic Spinal Cord Injury in Jos, North-Central Nigeria.

Spinal cord injury is a devastating condition and has been recognised so since antiquity with evolving pattern of presentation and outcome. This study aimed to review the clinical profile and determinants of early outcome in patients with traumatic spinal cord injury (TSCI) in Jos, Nigeria. This retrospective cohort study, reviewed the health records of all patients with TSCI that were managed, based on the neurosurgical unit protocol for the management of TSCI in our institution from 2011 to 2021. Relevant data were retrieved into a preformed pro forma, analysis was done for determinants of outcome using SPSS and presented in tables and figure. A total of 296 patients, aged 20-39 years, with male to female ratio of 5.2:1 were studied. The median time from injury to presentation was 96 h, and the cervical spine was the most (139, 47.0%) affected region. Most of the patients (183, 61.8%) had complete injury (ASIA A) at presentation, the average, first week mean arterial blood pressure (MAP) of 89.98 ± 8.86. Mortality was 73 (24.7%) at 6 weeks post injury and complete TSCI, cervical spinal cord segment and the average "first week" MAP were, independent predictors of mortality. The admission ASIA impairment scale (AIS) and injury to presentation interval were predictive of AIS improvement at 6 weeks and length of hospital stay (LOHs). We also found that AIS at admission, level of spinal cord affected and the average first week MAP were early predictors of mortality, while the injury to presentation interval and admission AIS, predicted improvement of AIS at 6 weeks. The LOHs was seen more in patients with severe AIS at admission and those who had delayed presentation.

Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.

Treatment of Sports Injuries in Orthopedic Surgery: Recent Advances

This article reviews the most recent advances in the literature regarding orthopedic surgery for sports injuries. For large-to-massive rotator cuff tears, non-surgical treatment yielded superior results at three months to surgical treatment, although surgical treatment provided better results over time. Arthroscopic partial repair without a posterior interval slide yielded superior results to complete arthroscopic rotator cuff repair with a posterior interval slide. Graft bridging yielded superior results to superior capsular reconstruction. In first-time shoulder dislocations, arthroscopic Bankart repair has yielded superior results to arthroscopic washout. In high-grade acromioclavicular separation, a single clavicle tunnel tendon graft construct is preferable to a double tunnel construct. In femoroacetabular impingement, patients treated with hip arthroscopy had superior short-term results to those treated with physiotherapy alone. The odds of needing anterior cruciate ligament (ACL) graft revision were 2.1-fold higher for patients using a hamstring autograft than those using a patellar bone-tendon-bone (BTB) autograft. The use of a patellar tendon graft reduced the risk of graft rupture. The return-to-sports rate was higher for patients who underwent surgery with a BTB autograft than those with an autograft hamstring. The combination of lateral extra-articular tenodesis and ACL reconstruction-ACLR (single-bundle hamstring autograft) decreased the risk of ACLR failure after two years of follow-up. In complete mid-substance ACL injuries, the bridge-enhanced ACL repair technique resulted in similar outcomes to autograft ACLR. Fresh-frozen allografts have been a good alternative to autografts in ACLR. In posterior medial meniscal root tears, root repair was associated with less arthritic progression than non-surgical treatment and partial meniscectomy. Medial patellofemoral ligament (MPFL) reconstruction has provided better results than MPFL repair in patellofemoral instability.

Repairing the Obturator Nerve in Robotic Pelvic Surgery: Make the Procedure more Perfect

We read with interest the excellent article by A. La Riva et al [1]. The authors represented five type of obturator nerve injury (ONI) that may occur during robotic pelvic surgery, included crush injury with a clip, transection injury, partial or complete transection with feasible approximation, complete transection with challenging approximation, complete ransection injury with hidden proximal nerve ending, and the corresponding management strategies, and the principle that the obturator nerve should be skeletonized and well identifified from its surrounding structures no matter what processes were preformed. We are totally agree with that, and we hope that the authors would reply some unapprehensive points from us.

Superficial temporal artery injury and delayed post-cranioplasty infection

ObjectiveComplications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. MethodsA retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. ResultsFifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). ConclusionsThere is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.

Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study.

The focus of this modified Delphi study was to investigate and build consensus regarding the medical management of children with moderate and severe acute spinal cord injury (SCI) during their initial inpatient hospitalization. This impetus for the study was based on the AANS/CNS guidelines for pediatric SCI published in 2013, which indicated that there was no consensus provided in the literature describing the medical management of pediatric patients with SCIs. An international, multidisciplinary group of 19 physicians, including pediatric neurosurgeons, orthopedic surgeons, and intensivists, were asked to participate. The authors chose to include both complete and incomplete injuries with traumatic as well as iatrogenic etiologies (e.g., spinal deformity surgery, spinal traction, intradural spinal surgery, etc.) due to the overall low incidence of pediatric SCI, potentially similar pathophysiology, and scarce literature exploring whether different etiologies of SCI should be managed differently. An initial survey of current practices was administered, and based on the responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as ≥ 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final meeting was held virtually to generate final consensus statements. Following the final Delphi round, 35 statements reached consensus after modification and consolidation of previous statements. Statements were categorized into the following eight sections: inpatient care unit, spinal immobilization, pharmacological management, cardiopulmonary management, venous thromboembolism prophylaxis, genitourinary management, gastrointestinal/nutritional management, and pressure ulcer prophylaxis. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines. General management strategies were similar for both iatrogenic (e.g., spinal deformity, traction, etc.) and traumatic SCIs. Steroids were recommended only for injury after intradural surgery, not after acute traumatic or iatrogenic extradural surgery. Consensus was reached that mean arterial pressure ranges are preferred for blood pressure targets following SCI, with goals between 80 and 90 mm Hg for children at least 6 years of age. Further multicenter study of steroid use following acute neuromonitoring changes was recommended.

Medial and lateral dual plating of native distal femur fractures: a systematic literature review.

Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature. Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score. The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality. Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.

Translated article] Correlation between the incidence of rotator cuff lesion in traumatic unilateral anterior glenohumeral dislocation and the contralateral shoulder

IntroductionAnterior glenohumeral dislocation in patients older than 60 years is related to rotator cuff lesion because of its pre-existing degenerative condition. However, in this age group, the scientific evidence fails to elucidate whether rotator cuff lesions are the cause or consequence of recurrent shoulder instability. The objective of this paper is to describe the prevalence of rotator cuff injuries in a series of consecutive shoulders in patients older than 60 years who suffered a first episode of traumatic glenohumeral dislocation, and its correlation with rotator cuff injuries in both shoulders. MethodsRetrospectively, 35 patients over 60 years of age who had a first episode of unilateral traumatic anterior glenohumeral dislocation and who had MRI of both shoulders were studied, evaluating both shoulders with MRI to determine the structural damage correlation of the rotator cuff and long head of the biceps between them. ResultsWhen assessing the existence of partial or complete injury to the supraspinatus and infraspinatus tendons, the concordance on the affected and healthy sides, we have shown concordant results on both sides in 88.6 and 85.7%, respectively. The Kappa concordance coefficient was 0.72 for supraspinatus and infraspinatus tendons tear. Of the total of 35 cases evaluated, 8 (22.8%) presented at least some alteration in the tendon of the long head of the biceps on the affected side and only one (2.9%) on the healthy side, where the Kappa coefficient of concordance was 0.18. Of the 35 cases evaluated, 9 (25.7%) presented at least some retraction in the tendon of the subscapularis muscle on the affected side, while no participant showed signs of retraction in the tendon of this muscle on the healthy side. ConclusionsOur study has found a high correlation of the presence of a postero-superior rotator cuff injury after presenting a glenohumeral dislocation between the shoulder that has suffered the event and the presumably healthy contralateral shoulder. Nevertheless, we have not found this same correlation with subscapularis tendon injury and medial biceps dislocation.

Cell therapies for spinal cord injury: a review of the clinical trials and cell-type therapeutic potential.

Spinal cord injury (SCI) is an as yet untreatable neuropathology that causes severe dysfunction and disability. Cell-based therapies hold neuroregenerative and neuroprotective potential, but, although being studied in SCI patients for more than two decades, long-term efficacy and safety remain unproven, and which cell types result in higher neurological and functional recovery remains under debate. In a comprehensive scoping review of 142 reports and registries of SCI cell-based clinical trials, we addressed the current therapeutical trends and critically analysed the strengths and limitations of the studies. Schwann cells, olfactory ensheathing cells (OECs), macrophages and various types of stem cells have been tested, as well as combinations of these and other cells. A comparative analysis between the reported outcomes of each cell type was performed, according to gold-standard efficacy outcome measures like the ASIA impairment scale, motor and sensory scores. Most of the trials were in the early phases of clinical development (phase I/II), involved patients with complete chronic injuries of traumatic aetiology and did not display a randomized comparative control arm. Bone marrow stem cells and OECs were the most commonly tested cells, while open surgery and injection were the main methods of delivering cells into the spinal cord or submeningeal spaces. Transplantation of support cells, such as OECs and Schwann cells, resulted in the highest ASIA Impairment Scale (AIS) grade conversion rates (improvements in ∼40% of transplanted patients), which surpassed the spontaneous improvement rate expected for complete chronic SCI patients within 1 year post-injury (5-20%). Some stem cells, such as peripheral blood-isolated and neural stem cells, offer potential for improving patient recovery. Complementary treatments, particularly post-transplantation rehabilitation regimes, may contribute highly to neurological and functional recovery. However, unbiased comparisons between the tested therapies are difficult to draw, given the great heterogeneity of the design and outcome measures used in the SCI cell-based clinical trials and how these are reported. It is therefore crucial to standardize these trials when aiming for higher value clinical evidence-based conclusions.

BILATERAL DECOMPRESSIVE CRANIECTOMY IN A PATIENT WITH HEAD INJURIES DUE TO GUN PROJECTILE: A CASE REPORT

A 38-year-old male patient with multiple skull injuries caused by a small-caliber firearm projectile whose entry hole was the right eye after being attacked when leaving his home. Consequently, he presented head trauma with multifragmented fracture of the cranial vault causing exposure of the brain mass in the bilateral frontoparietal region and complete injury to the right eyeball with fracture of the orbit in its posterior, lateral, medial, roof and floor walls. He was transferred to the General Hospital of Axapusco, where the patient was received with 8 points on the Glasgow scale and a simple tomography of the skull was performed, observing injury to both hemispheres, bilateral subarachnoid hemorrhage, parasagittal hemorrhagic contusions and cerebral edema, predominantly affecting to the corpus callosum and cingulum. Therefore, hinge-type decompressive craniectomy and debridement in the first 12 hours of trauma were determined as surgical treatment. It should be noted that a favorable recovery was obtained without associated complications. It is concluded that the surgical treatment of choice is early decompressive craniectomy when the patient presents less than 9 points on the Glasgow Coma Scale at admission, the injury along the path of the wound is bihemispheric and posterior fossa, the time that elapses from the injury to the performance of the surgery is within the first 12 hours, there is pupillary reactivity and the age of the patient is greater than 35 years.

Reliability and assessment of partial or complete anterior cruciate ligament injuries with diagnostic arthroscopy

Background: Partial tears of anterior cruciate ligament (ACL) were more commonly identified in young group with knee twisting. Partial tears are characterized by tear involvement of less than 50% of the ligament is torn. The arthroscopic evaluation is considered as gold standard in diagnostic evaluation. The comparison of findings between partial and complete tears in magnetic resonance imaging (MRI) and arthroscopy helps in finding out reliability of diagnostic modalities and consider the surgeon to establish the plan of treatment. Methods: 2-year prospective study at the department of orthopedics, RRMCH, Bangalore, India. 40 consecutive patients with suspicion of cruciate injuries of knee were selected for the study from July 2018 to May 2021. The MR imaging of knee in selected cases were performed and the findings were obtained. The descriptive statistical analysis was prepared which includes spectrum of MRI findings in cruciate injuries of knee that were correlated with arthroscopy findings in determining the accuracy. Results: Total 40 patients, we obtained 100% sensitivity and 66.67% specificity, 93.75% accuracy of MRI with arthroscopy in diagnosing complete ACL tears. We obtained 90.91% sensitivity and 80% specificity, 87.50% accuracy of MRI with arthroscopy in diagnosing partial ACL tears. Conclusions: The partial tears can be missed or can be over diagnosed on MRI. These misinterpretations are more likely to happen due to intra-substance signal abnormality. Description of the status of ACL ligament in arthroscopy helped the orthopaedic surgeons in decision making as conservative approach in partial tears and reconstruction in a complete tear.

Epidemiological study of thoracolumbar spine fracture patients reported to tertiary care center of Central India

Background: Thoracic and lumbar spine fractures account for 90% of all spine fractures recorded. In low- and middle-income countries, spinal injuries are associated with significant disability and decreased life expectancy. Non-operatively, these injuries can be managed with a thoracolumbar orthosis or hyperextension cast. The operative management with a posterior, anterior or combined approach will offer immediate mobilization and earlier rehabilitation, providing a better environment for restoration of neurological function. Aim of the study was to find out epidemiology of patients with thoracolumbar spine fracture patients. Methods: A cross sectional observational study was conducted in department of orthopaedics at tertiary care, teaching hospital among patients with traumatic thoracolumbar spine fractures. Epidemiological data variables were collected. In statistical analysis data from 60 patient reported was recorded and analysed. Results: Fall from height is the leading mechanism of injury among middle aged people (30-60years) with male predominance, accounting for 58.33 percent of all spinal cord injury cases. The majority (45%) of fractures were of the burst kind, followed by compression (28.3%), and then translation/rotation (21.6%). And the most-rare of all was the distracted type (just 5%). An only 15% of patients had had a complete spinal injury, whereas the remaining 85% had sustained incomplete/ no spinal cord injury. Conclusions: Knowledge about the burden brought on by spinal cord injury makes it clear that preventing such injuries is the backbone of care. preventive measures for high-risk individuals and early definitive response by paramedics can help reducing the load caused by these injuries.

A Surgical Framework for the Management of Incomplete Axillary Nerve Injuries.

Axillary nerve injury is the most common nerve injury affecting shoulder function. Nerve repair, grafting, and/or end-to-end nerve transfers are used to reconstruct complete neurotmetic axillary nerve injuries. While many incomplete axillary nerve injuries self-resolve, axonotmetic injuries are unpredictable, and incomplete recovery occurs. Similarly, recovery may be further inhibited by superimposed compression neuropathy at the quadrangular space. The current framework for managing incomplete axillary injuries typically does not include surgery. This study is a retrospective analysis of 23 consecutive patients with incomplete axillary nerve palsy who underwent quadrangular space decompression with additional selective medial triceps to axillary end-to-side nerve transfers in 7 patients between 2015 and 2019. Primary outcome variables included the proportion of patients with shoulder abduction M3 or greater as measured on the Medical Research Council (MRC) scale, and shoulder pain measured on a Visual Analogue Scale (VAS). Secondary outcome variables included pre- and postoperative Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores. A total of 23 patients met the inclusion criteria and underwent nerve surgery a mean 10.7 months after injury. Nineteen (83%) patients achieved MRC grade 3 shoulder abduction or greater after intervention, compared with only 4 (17%) patients preoperatively (p = 0.001). There was a significant decrease in VAS shoulder pain scores of 4.2 ± 2.5 preoperatively to 1.9 ± 2.4 postoperatively (p < 0.001). The DASH scores also decreased significantly from 48.8 ± 19.0 preoperatively to 30.7 ± 20.4 postoperatively (p < 0.001). Total follow-up was 17.3 ± 4.3 months. A surgical framework is presented for the appropriate diagnosis and surgical management of incomplete axillary nerve injury. Quadrangular space decompression with or without selective medial triceps to axillary end-to-side nerve transfers is associated with improvement in shoulder abduction strength, pain, and DASH scores in patients with incomplete axillary nerve palsy.

Experience in Microsurgical Treatment of Complete Scalp Avulsion.

Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction. Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed. Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance. Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.

Falls During Inpatient Rehabilitation After Spinal Cord Injury: Characterization, Clock-Hour Visualization, and Time to Event Predictors

ObjectivesTo (1) determine fall characteristics (eg, cause, location, witnesses) of inpatients with spinal cord injury (SCI) and whether they were different for ambulatory persons vs wheelchair users; (2) visualize the total number of daily falls per clock-hour for different inpatients’ features (eg, cause of injury, age); (3) compare clinical and demographic characteristics of inpatients who experienced a first fall event vs inpatients who did not experience such event; and (4) identify first fall event predictors. DesignRetrospective observational cohort study. SettingInstitution for inpatient neurologic rehabilitation. ParticipantsPersons with SCI (N=1294) admitted to a rehabilitation facility between 2005 and 2022. InterventionsNot applicable. Main Outcome MeasuresFunctional independence measure (FIM), Hospital Anxiety and Depression Scale (HADS), American Spinal Injury Association Impairment Scale (AIS), and Spinal Cord Independence Measure (SCIM) at admission. Kaplan-Meier survival curves and Cox proportional hazards models were used. ResultsA total of 502 fall events were experienced by 369 ambulatory inpatients (19.8%) and wheelchair users (80.2%) in 63.9% of cases being alone, with cause, situation, and location significantly different in both groups. Clock-hour visualizations revealed an absolute peak at 12 AM (complete or incomplete injuries, with paraplegia or tetraplegia) but a relative peak at 9 AM mainly including incomplete patients with paraplegia. Of the (n=1294) included patients, 16.8% experienced at least 1 fall. Fallen patients reported higher levels of HADS depression, lower total SCIM, and longer time since injury to admission, with no differences in age, sex, educational level, FIM (quasi-significant), and AIS grade. Multivariable Cox proportional hazards identified time since injury to admission and AIS grade D as significant predictors of first fall event. ConclusionsFalls identification, characterization, and clock-hour visualization can support decisions for mitigation strategies specifically addressed to inpatients with SCI. Fall predictors were identified as a first step for future research.

Para-Cyclists Present Impaired Lung Function and Mechanics Independent of Peripheral and Respiratory Muscle Strength

Objective: The present study investigated the possible changes in respiratory function and mechanics in paralympic cyclists in comparison with cyclists. Design: Lung function (spirometry) and mechanics (impulse oscillometry) pre- and post-bronchodilator, the levels of FeNO and the peripheral and respiratory muscle strength were evaluated in paralympic cyclists [spinal injury from C5 (incomplete injury) until T11 (complete injury); (n=8)] and cyclists (n=12). Results: Paralympic cyclists presented reduced FVC, FEV1, PEF, VC In and MEF75%. Of note, only athletes presented response to bronchodilator, as observed for FEV and for FVC/FEV1. Respiratory impedance (Z5Hz), total respiratory system resistance (R5Hz) was impaired in paralympic cyclists. No differences were found hand grip and respiratory muscle strength and for FeNO comparing paralympic cyclists with cyclists. Conclusion: We conclude that para-cyclists present impaired lung function and mechanics and that such impairments are not correlated with reduction in the respiratory or peripheral muscle strength or with pulmonary inflammation.