Distraction Injury Research Articles

Nonoperative Management of Isolated Thoracolumbar Flexion Distraction Injuries: A Single-Center Study.

Nonoperative management is an appealing option for purely transosseous thoracolumbar flexion-distraction injuries given the prospects of osseous healing and restoration of the posterior tension band complex. This study seeks to examine differences in outcomes following flexion-distraction injuries after operative and nonoperative management. This study reviews all patients at a single Level 1 trauma center from 2004 to 2022 with AO Spine B1 thoracolumbar injuries treated operatively vs nonoperatively. Inclusion criteria were age greater than 16 years, computed tomography-confirmed transosseous flexion-distraction injuries, and at least 3 months of follow-up with available imaging. The primary outcome assessed was a change in local Cobb angles, with secondary outcomes consisting of complications, time to return to work, and need for subsequent operative fixation. Initial Cobb angles in the operative (n = 14) vs nonoperative group (n = 13) were -5° and -13°, respectively (P = 0.225), indicating kyphotic alignment in both cohorts. We noted a significant difference in Cobb angles between cohorts at first follow-up (2.6° and -13.9°, P = 0.015) and within the operative cohort from presentation to first follow-up (P = 0.029). At the second follow-up, there was no significant difference in Cobb angles between cohorts (3.6° and -12.6°, P = 0.07). No significant differences were noted in complication rates (P = 1), time to return to work (P = 0.193), or resolution of subjective back pain (P = 0.193). No crossover was noted. Nonoperative management of minimally displaced transosseous flexion-distraction injuries is a safe alternative to surgery. Patient factors, such as compliance with follow-up, and location of the injury should be factored into the surgeon's management recommendation. Overall, no significant differences in outcomes and complications were noted following nonoperative management of AO Spine B1 injuries, indicating the potential for these injuries to be managed conservatively.

A non-linear and interaction effect analysis of various risk factors influencing mobile phone use while driving among long-haul truck drivers travelling across India

Mobile phone use while driving (MPWD) is one of the most critical behaviours contributing to distraction related fatalities and injuries. However, MPWD is not well understood among long-haul truck drivers (LHTDs) especially in developing countries like India. The present study aims to develop a prediction model for MPWD and attempts to identify the underlying factors and patterns affecting MPWD among LHTDs travelling across India. A total of 756 valid samples were collected utilising a questionnaire in Salem city, Tamil Nadu, India. Machine learning algorithms including Decision tree, Random Forest, Adaptive Boosting, and Extreme gradient boosting were employed to model MPWD. A split ratio of 70:30 was adopted for training and testing purposes. A 10-fold cross validation procedure was carried out during model development. The analysis results showed that XGBoost demonstrated superior performance than other models (accuracy = 0.82, F1 score =0.8, and AUROC = 0.82). In addition, SHapley Additive explanations (SHAP) were implemented to reveal the importance of predictors contributing to MPWD. The findings of the study showed that type of commodity, pressured delivery, calls received during driving, smoking habits, educational level, and continuous driving duration as major factors contributing to MPWD among LHTDs. SHAP values were also utilised to investigate hidden patterns and interaction effects for major factors affecting MPWD. Parcel and food items coupled with frequent pressured delivery and middle aged LHTDs driving continuously for 5–6 h are some of the interactive risk factors enhancing MPWD. These findings are useful for road safety authorities and truck companies to draft suitable policies and help to introduce effective interventions for reducing MPWD among LHTDs.

Complete cervical spinal cord transection cephalad to noncontiguous sub-axial vertical distraction injury: a rare complex injury case report, surgical technique and literature review

Complete cervical spinal cord transection cephalad to noncontiguous sub-axial vertical distraction injury: a rare complex injury case report, surgical technique and literature review

Surgeon variation: a south african spinal pathology treatment survey.

To investigate variation in treatment decisions among spine surgeons in South Africa and the association between surgeon characteristics and the treatment they select. We surveyed 79 South African spine surgeons. We presented four vignettes (cervical spine distractive flexion injury, lumbar disc herniation, degenerative spondylolisthesis with stenosis, and insufficiency fracture) for them to assess and select treatments. We calculated the index of qualitative variation (IQV) to determine the degree of variability within each vignette. We used Fisher's exact, and Kruskal-Wallis tests to assess the relationships between surgeons' characteristics and their responses per vignette. We compared their responses to the recommendations of a panel of spine specialists. IQVs showed moderate to high variability for cervical spine distractive flexion injury and insufficiency fracture and slightly lower levels of variability for lumbar disc herniation and degenerative spondylolisthesis with stenosis. This confirms the heterogeneity in South African spine surgeons' management of spinal pathologies. The surgeon characteristics associated with their treatment selection thatwere important were caseload, experience and training, and external funding. Also, 19% of the surgeons selected a treatment option that the Panel did not support. The findings make a case for evaluating patient outcomes and costs to identify value-based care. Such research would help countries that are seeking to contract with providers on value. Greater uniformity in treatment and easily accessible outcomes reporting would provide guidance for patients. Further investment in training and participation in fellowship programs may be necessary, along with greater dissemination of information from the literature.

Fracture-dislocations of the subaxial cervical spine

Fracture-dislocations of the subaxial cervical spine are rare yet potentially devastating injuries often associated with high-energy trauma. These inherently unstable injuries frequently lead to neurologic compromise, necessitating urgent operative intervention. This review provides a comprehensive overview of subaxial cervical spine fracture-dislocations, addressing their epidemiology, anatomy, and classification systems. Classification schemes including Allen and Ferguson, Cervical Spine Injury Severity Score (CSISS), Subaxial Cervical Spine Injury Classification System (SLIC), and AO Spine Subaxial Cervical Spine Injury Classification System are discussed. Prompt recognition and management of these injuries is critical in optimizing long-term functional and neurologic outcomes. Rates of neurologic injury can exceed 50 %, with distractive flexion injuries and bilateral facet injuries often presenting with higher ASIA grades and lower neurologic recovery potential. Minimizing time to reduction is the most important factor in optimizing neurologic outcomes in these injury patterns. We discuss both closed and open reduction methods, timing considerations, technical pearls, and potential complications associated with each strategy. We also discuss the diagnosis and management of concurrent acute disk herniations, the role of advanced imaging, and the debated utility of pre-reduction MRI. Many subaxial cervical fracture-dislocations necessitate surgical intervention, which can be approached from an anterior, posterior, or combined approach. Although no standard surgical treatment algorithm exists, we discuss surgical options and situations where a preferred approach may exist. Selection of the approach depends on injury characteristics and surgeon preference, and there are no clearly defined surgical recommendations based on injury pattern.

Definition, Frequency and Risk Factors for Intra-Operative Spinal Cord Injury: A Knowledge Synthesis.

Mixed-methods approach. Intra-operative spinal cord injury (ISCI) is a devastating complication of spinal surgery. Presently, a uniform definition for ISCI does not exist. Consequently, the reported frequency of ISCI and important risk factors vary in the existing literature. To address these gaps in knowledge, a mixed-methods knowledge synthesis was undertaken. A scoping review was conducted to review the definitions used for ISCI and to ascertain the frequency of ISCI. The definition of ISCI underwent formal review, revision and voting by the Guidelines Development Group (GDG). A systematic review of the literature was conducted to determine the risk factors for ISCI. Based on this systematic review and GDG input, a table was created to summarize the factors deemed to increase the risk for ISCI. All reviews were done according to PRISMA standards and were registered on PROSPERO. The frequency of ISCI ranged from 0 to 61%. Older age, male sex, cardiovascular disease including hypertension, severe myelopathy, blood loss, requirement for osteotomy, coronal deformity angular ratio, and curve magnitude were associated with an increased risk of ISCI. Better pre-operative neurological status and use of intra-operative neuromonitoring (IONM) were associated with a decreased risk of ISCI. The risk factors for ISCI included a rigid thoracic curve with high deformity angular ratio, revision congenital deformity with significant cord compression and myelopathy, extrinsic intradural or extradural lesions with cord compression and myelopathy, intramedullary spinal cord tumor, unstable spine fractures (bilateral facet dislocation and disc herniation), extension distraction injury with ankylosing spondylitis, ossification of posterior longitudinal ligament (OPLL) with severe cord compression, and moderate to severe myelopathy. ISCI has been defined as "a new or worsening neurological deficit attributable to spinal cord dysfunction during spine surgery that is diagnosed intra-operatively via neurophysiologic monitoring or by an intraoperative wake-up test, or immediately post-operatively based on clinical assessment". This paper defines clinical and imaging factors which increase the risk for ISCI and that could assist clinicians in decision making.

Flexion–distraction injuries of the spine: Features of diagnostics, clinical picture, and results of surgical treatment of children

BACKGROUND: Flexiondistraction injuries of the spine result from high-energy trauma (traffic accidents and falls from a height). This type of injury is commonly found in the thoracolumbar junction. Among combined injuries in the presence of flexiondistraction fractures of the vertebral column, injuries of the chest or abdominal organs are often observed, which are crucial for patient survival, and their diagnostic measure is complex because of the severe and unstable conditions of the patients.
 AIM: To analyze a cohort of pediatric patients who underwent surgery for flexiondistraction injury of the spine.
 MATERIALS AND METHODS: We analyzed the data of clinical and instrumental studies and surgical outcomes of 28 pediatric patients (aged 217 years) with flexiondistraction injuries of the spine. The standard preoperative examination included clinical and laboratory studies, spondylography, multislice spiral computed tomography and magnetic resonance imaging of the damaged area, electrocardiography, and ultrasonography of the abdominal organs and kidneys. All patients underwent surgery for the correction and stabilization of traumatic spinal deformity with a multisupport metal structure and posterior local fusion. The analysis included an assessment of the mechanism of injury, concomitant injuries, time elapsed after the injury before admission to the hospital, level of the damaged segment, and treatment. Data were processed statistically using an online calculator. The nonparametric MannWhitney method was used.
 RESULTS: Catatrauma was the leading cause of injury in 50% of the patients, compared with traffic accidents in 36%. In 80% of the patients, spinal injury was localized at the thoracolumbar junction and lumbar spine. Moreover, 71% of the patients were transferred to the National Research Center for Childrens Orthopedics and Trauma Surgery for surgical treatment on the spine in the early stages after injury (up to 7 days), and 8 children (19%) were admitted within 1045 days (average 16 days). In 19 (68%) patients, in addition to spinal injury, concomitant injuries occurred, with skeletal trauma and injuries of the abdominal cavity organs as the most frequent. All patients achieved complete correction of the deformity at the level of the damaged segment.
 CONCLUSIONS: Flexiondistraction fractures of the spine in children are characterized by a high incidence of concomitant injuries, which dictates the need for a full examination to identify them and correctly interpret the data. The elimination of mechanical instability in the early stages in this type of injury can reduce the extent of fixation and contribute to the restoration of the physiological profile and disk apparatus of the spinal column.

Characterization of the influence of spinopelvic parameters on thoracolumbar trauma.

The current Roussouly classification identifies four groups of "normal" sagittal spine morphology, which has greatly expanded the understanding of normal heterogeneity of the spine. While there has been extensive characterization of the influence of spinopelvic parameters on outcomes after degenerative spine surgery, the influence of spinopelvic parameters on thoracolumbar trauma has yet to be described. The goal of this study was to determine if spinopelvic parameters and global spine morphology influence fracture location, fracture morphology, and rate of neurological deficit in the setting of thoracolumbar trauma. Of 2896 patients reviewed in the authors' institutional spine database between January 2014 and April 2020 with an ICD-9/10 diagnosis of thoracolumbar trauma, 514 met the inclusion criteria of acute thoracolumbar fracture on CT and visible femoral heads on sagittal CT. Pelvic incidence (PI) was calculated on sagittal CT. Demographic and clinical data including age, sex, BMI, smoking status, concomitant cervical fracture, mechanism of injury, major fracture location, neurological deficit, AO Spine thoracolumbar injury classification, and management type (operative vs nonoperative) were collected. Patients were stratified into high-PI (≥ 50°) and low-PI (< 50°) groups. Patients with high PI had a lower incidence of fractures in the lower lumbar spine (below L2) compared with patients with low PI (16% vs 8%, p < 0.01). The last lordotic vertebrae were observed between T10 and L4, and of fractures that occurred at these levels, 75% were at the last lordotic vertebrae. Fall from height was the most common cause of neurological deficit, accounting for 47%. Of the patients presenting with a fall from height, AO Spine type B distraction injuries were more common in the high-PI group (41% vs 18%, p = 0.01). Similarly, within the same subgroup, AO Spine type A compression injuries were more common in the low-PI group (73% vs 53%, p = 0.01). Spinopelvic parameters and sagittal balance influence the location and morphology of thoracolumbar fractures. Fractures of the thoracolumbar junction are strongly associated with the inflection point, which is defined by sagittal alignment. While the importance of considering sagittal balance is known for decision-making in degenerative spinal pathology, further studies are required to determine if spinopelvic parameters and sagittal balance should play a role in the decision-making for management of thoracolumbar fractures.

Fracture Dislocation in the Cervical Spine – A Case Series Analysis of 32 Cases and Review of Literature

Abstract Complex cervical spine injuries result from road traffic accidents, fall from height, diving in the swimming pool, fall along with the ladder etc. This is a major cause of disability, morbidity and mortality and dependence. Most of these injuries are preventable by proper care, social reforms, teaching civic sense to students at an early age, adoption of safety measures while climbing heights, enforcement of traffic rules, building up of infrastructure, educating the people and mandatory emergency room service for the offenders. Fracture dislocations of the cervical spine mostly flexion distraction injuries. Dislocations can range from perched facets, unilateral facet dislocations to bilateral facet dislocations and spondyloptosis. These result in varying degrees of neurological deficit. The recovery of these patients depend on the initial magnitude of the injury, the safe transport of the victim to the trauma centre, careful management of the injuries and rehabilitation. Here a case series of 32 patients with varying degrees of fracture dislocations of the cervical spine are analyzed retrospectively.

Surgical outcome of locked facet in distractive flexion injury of the subaxial cervical spine: Single institution retrospective study.

The optimal surgical treatment for patients suffering from distractive flexion injury of the subaxial cervical spine with a locked facet (LF) is unknown. Closed reduction via an anterior or posterior approach is a treatment option for LF. We examined the surgical outcomes of patients treated for locked facet distractive flexion injury (LF-DFI) in this case series, with a particular emphasis on the surgical approach and reduction maneuver. We retrospectively analyzed the patients with distractive flexion injury of the subaxial cervical spine who underwent surgery at our hospital between November 2006 and April 2021. Patients who did not have facet subluxation or dislocation or those who achieved LF reduction prior to skin incision were excluded from this study. The patients were divided into 2 groups based on their initial approach, anterior or posterior approach. Perioperative clinical outcomes, including the American Spinal Cord Injury Association scale score, radiological changes, and complications were analyzed. This study enrolled 12 patients with LF-DFI. Four and 8 patients underwent the anterior and posterior approaches, respectively. The LF was reduced using an anterior approach with traction between the vertebral bodies in the anterior approach group and using a posterior approach with partial facetectomy in the posterior approach group. The preoperative American Spinal Cord Injury Association scale scores were as follows: A, 1 patient; B, 1 patient; C, 3 patients; D, 4 patients; and E, 3 patients. Nine patients showed no neurologic deterioration after surgery, whereas 2 had an aggravated neurologic status. Postoperatively, patients who underwent posterior open reduction did not exhibit worsened neurologic symptoms, whereas 2 patients who underwent the anterior approach showed worsened neurologic symptoms. At the final follow-up, all patients achieved radiological fusion, and no complications other than neurologic deterioration were identified. In terms of worsening postoperative neurologic status, a posterior approach using partial facetectomy for LF reduction is considered a safer surgical technique than an anterior approach. To avoid iatrogenic intraoperative cord injury, we recommend posterior approach in patients with LF-DFI.

Pathogenesis and pathomorphology of distraction trauma in the framework of pre-trial investigations of cruelty to animals

The importance of identification and differential diagnosis of spinal injuries, in the case of polytrauma, the ability to distinguish the pathogenesis of various injuries are important and relevant both during clinical and during pathological examination of the animal’s body. The purpose of research is to provide veterinary practitioners and lawyers with strategies for identifying the cause (mechanism) of spinal cord injury and to assist triers of fact (decision-makers) in arriving at plausible and reasoned veterinary forensic conclusions. The research was performed using pathological and anatomical dissection and histological studies. It was established that damage to the cervical spinal cord due to traumatic bending of the neck was accompanied by partial or complete rupture of the intervertebral disc and destruction of the ligaments of the vertebrae. It was found that the hyperemia of the vessels of the meninges of the brain is the result of blood circulation disorders in the occipital artery and the caudal artery of the meninges, and mechanical damage to the integrity of the intervertebral discs or the destruction of the ligaments of the neck vertebrae led to various disorders of the innervation of various organs and systems of the body and ended the death of animals. It was proved that the distraction injury of the cervical spine led to the swelling of the medulla of the brain, haemorrhages of the caudalventral part of the brain substance. It was found that irritation of nervus vagus led to hyperemia of vessels of large (aorta and trunk of pulmonary artery) caliber, cranial mesenteric artery) caudal mesenteric artery and, accordingly, hyperemia of thoracic and abdominal organs. Application of research results will help in differentiation of various types of mechanical injuries of the spine (including differentiation from other pathological conditions of the body), determination of the area of the applied force vector

438 Benefits of Short- Versus Long-segment Fixation for the Treatment of Thoracolumbar Chance Fractures: A Comparison of Perioperative and Radiological Outcomes

INTRODUCTION: Discussion continues regarding optimal surgical management of thoracolumbar fractures. Some have indicated long-segment posterior fixation (LSPF) is favorable when evaluating implant stability, kyphotic deformity, and pain. However, most studies either included multiple fracture subtypes or focused on burst fractures. Short-segment fixation (SSPF) may be similarly effective for a subset of patients while minimizing surgical time and length of stay (LOS). This study reviews inpatient and follow-up outcomes of chance fractures managed with SSPF versus LSPF. METHODS: Retrospective review of 50 consecutive patients with thoracolumbar distraction injuries (AO B1 and B2) at a single center over a five-year period. Patients underwent pedicle fixation one level (SSPF) or two to three levels (LSPF) above and below the fracture. Patient demographics, preoperative characteristics, and perioperative outcomes were compared between groups. Radiological outcomes were assessed by measuring Cobb angles immediately postoperatively and up to 12 months postoperatively. RESULTS: There was a 31% reduction in mean surgical time for SSPF patients vs LSPF (134 vs 195 minutes, independent samples t test, p = 0.037) without a significant difference in ICU LOS (4.6 vs 4.8 days, independent samples t test, p = 0.947), hospital LOS (15 vs 14 days, independent samples t test, p = 0.865) or complication rates (2 of 35 vs 2 of 15 patients, Fisher’s Exact, p = 0.574). Longitudinal assessment of kyphosis by measuring Cobb angles immediately postoperatively and 2 - 4, 6, 8 - 12, and &gt; 12 months postoperatively showed no significant differences in radiological outcomes between groups. There was a trend toward an increased likelihood of discharge to home (Likelihood ratio = 5.299, ꭓ2 test, p = 0.032) with SSPF. CONCLUSIONS: SSPF is non-inferior to LSPF for thoracolumbar chance fractures while offering reduced surgery time. Our results additionally suggest SSPF may offer increased likelihood of discharge home.

Traction-related complications in hip arthroscopy for 26 years. A systematic review.

The primary aim of the study is to determine the rate of traction-related complications in hip arthroscopy (HA) including perineal compression and distraction injuries, and the secondary objective is to report the incidence of complications in HA found on the studies selected by a systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for data extraction from the PubMed and Cochrane databases obtained in February 2022. Reviewers extracted the title, author, date of publication, number of hips treated and number of complications describing the affected area, nerve and soft tissue injury related to traction. Studies on postless HA and HA combined with other procedures were excluded. Twenty-six years of HA literature was found in the search that included 35 studies and 8126 hips (89% Level IV) that reported the complications found during the procedure and described complications related to traction. A total of 623 hips (7.7%) had some sort of complications during HA, and complications related to traction were in 227 hips (36%). Injuries caused specifically by the perineal compression were in 144 hips (23%) that included the pudendal nerve and soft tissue injury of the groin area. Complications caused by the distraction were in 83 hips (13%) that included sciatic and peroneal nerve injury, numbness or pain of ankle and foot. HA complications occurred in 7.7% of hips treated, which is found in this systematic review. One-third of the complications are related to traction, 23% are caused by perineal compression and 13% are caused by distraction.

Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Background: Motor vehicle crashes (MVC) cause variable injury to the thoracolumbar (TL) region of children secondary to rapid deceleration from seatbelts. This mechanism can also predispose a child to intraabdominal injury (IAI), which necessitates early diagnosis to limit morbidity and mortality. While the maximum extent of TL spine injury can be appreciated shortly after presentation, the severity of IAI may not be appreciated until days later. It is hypothesized that a measure of TL-injury severity will identify patients at risk of concomitant IAI.Methods: Retrospective chart review identified 72 children with MVC-related TL spine injuries from 2007-2020. Patients were grouped based on the presence of IAI and TL spine injury (N=33) compared to isolated TL spine injury (no IAI, N=39). TL spine injury severity was classified according to the Thoracolumbar Injury Classification and Severity Scale (TLICS).Results: Demographics were similar in both groups. Children with concomitant IAI had primarily lumbar spine injuries, while injuries without associated IAI were more broadly distributed throughout the thoracolumbar spine. Children without concomitant IAI were more likely to sustain compression fractures (n=31, 79%), while children with IAI had more distraction injuries (n=24, 73%). TL injuries associated with IAI were significantly more severe than isolated TL injuries (median TLICS=7 [range: 1-9] vs. 1 [range: 1-10], p<0.001). As hypothesized, increasing TLICS is associated with an increased risk of concomitant IAI, such that for every point increase in TLICS, the risk of IAI increases 49% (OR: 1.492, [95% CI 1.254-1.817], AROC 0.795).Conclusions: Given the association between severe spine injury and IAI, this study examines the utility of TLICS score at presentation to establish an index of suspicion for concomitant IAI. While other clinical signs may be suggestive of the presence of IAI, our study may provide clinicians with another data point suggestive of spine injury severity in their diagnostic toolbox to optimally manage pediatric patients after MVC.Level of Evidence: III, Retrospective Cohort StudyKey Concepts•Pediatric patients are at risk for sustaining seatbelt syndrome (intraabdominal injury (IAI) associated with spinal column injury) after motor vehicle collisions when restraints are used improperly.•Occult IAIs may not be readily diagnosed with initial trauma workup and require a high index of suspicion to avoid delay in diagnosis and potential morbidity and mortality.•IAI is more frequently associated with spine fractures located in the lumbar spine.•IAI is associated with more severe spine injury (represented by Thoracolumbar Injury Classification and Severity Scale [TLICS] score >5).

Blunt cerebrovascular injuries in association with craniocervical distraction injuries: A retrospective review of consecutive cases

Blunt cerebrovascular injuries in association with craniocervical distraction injuries: A retrospective review of consecutive cases

The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)

ObjectiveTo determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury. MethodsAdult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score. ResultsThere were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001). ConclusionIn PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.

Causal mediation analysis of the impacts of distracted driving on crash injury risks

Distracted driving can pose great risks to road traffic safety. Although there is a rich body of literature devoted to identifying the statistical association between distracted driving and crash risks, few are available to examine the causal effect mechanism of distracted driving. Thus, the study attempts to conduct the causal mediation analysis to reveal the impact mechanism of distracted driving on crash injury risks, in which various hazardous driving actions are used as the mediators between driver distraction and crash injuries. Sensitivity analysis is also carried out to validate the underlying assumption of causal mediation analysis. The analytic results indicate that 1) distracted driving can lead to a higher likelihood of hazardous driving actions such as failing to yield, disobeying traffic control devices, driving left of lane center, and failing to stop in assured clear distance, 2) both the driver distraction and hazardous actions are the contributory factors to the severe crash injuries, and 3) distracted driving is identified to have significant mediation effects on crash injury risks. The study confirms the causal mediation effects of distracted driving on crash injury risks, which can serve to propose specific safety countermeasures to mitigate the crash injury risks.

Identification of injury type using somatosensory and motor evoked potentials in a rat spinal cord injury model.

The spinal cord is at risk of injury during spinal surgery. If intraoperative spinal cord injury is identified early, irreversible impairment or loss of neurological function can be prevented. Different types of spinal cord injury result in damage to different spinal cord regions, which may cause different somatosensory and motor evoked potential signal responses. In this study, we examined electrophysiological and histopathological changes between contusion, distraction, and dislocation spinal cord injuries in a rat model. We found that contusion led to the most severe dorsal white matter injury and caused considerable attenuation of both somatosensory and motor evoked potentials. Dislocation resulted in loss of myelinated axons in the lateral region of the injured spinal cord along the rostrocaudal axis. The amplitude of attenuation in motor evoked potential responses caused by dislocation was greater than that caused by contusion. After distraction injury, extracellular spaces were slightly but not significantly enlarged; somatosensory evoked potential responses slightly decreased and motor evoked potential responses were lost. Correlation analysis showed that histological and electrophysiological findings were significantly correlated and related to injury type. Intraoperative monitoring of both somatosensory and motor evoked potentials has the potential to identify iatrogenic spinal cord injury type during surgery.

Rare case of real-time observation of paralytic deterioration after cervical dislocation in the hyperacute phase

BackgroundThere have been no prior reports of real-time detailed records leading to complete quadriplegia immediately after fracture dislocation in high-energy trauma. Here, we report a case of cervical dislocation in which the deterioration to complete motor paralysis (modified Frankel B1) and complete recovery (Frankel E) could be monitored in real time after reduction in the hyperacute phase.Case presentationA 65-year-old man was involved in a car accident and sustained a dislocation at the C5/6 level (Allen–Ferguson classification: distractive flexion injury stage IV). His paralysis gradually deteriorated from Frankel D to C 2 hours after the injury and from Frankl C to B 5 hours after the injury. His final neurological status immediately before reduction was Frankel B1 (complete motor paralysis with sensation only in the perianal region). Reduction was completed within 6 h and 5 min after injury, and spinal fusion was subsequently performed. The patient exhibited rapid motor recovery immediately after surgery, and was able to walk independently on postoperative day 14.ConclusionsThis case suggests that there is a mixture of cases in which the spinal cord has not been catastrophically damaged, even if the patient has complete motor paralysis. Prompt reduction has the potential to improve neurological function in such cases.

Elbow Injuries in Children

Elbow Injuries in Children