Limb Fractures Research Articles

Traumatological emergencies: epidemiological and problematic aspects of care in the orthopedics traumatology department of the CHU Ignace Deen in Conakry

Background: A trauma emergency is any aggression (direct or indirect) external to the body for which no therapeutic delay is allowed at the risk of endangering the patient's life or the functional prognosis of his limbs. The objective of this study was to report the results of the management of traumatological emergencies. Methods: This was a descriptive cross-sectional study from 11 January 2021, to 11 July 2021. It focused on patients seen for traumatological emergencies in the CHU Ignace Deen Orthopaedics-Traumatology department. Results: Trauma emergencies constitute 75.2% of admissions to the emergency department. The average age of the patients was 32.2 years, with extremes of 1 and 91 years. There was a predominance of 76.3% males with a ratio (M/F) of 3.2. Road traffic accidents were the most found aetiology in 82.9%, and motorcycles were involved in 68.7%. Limb fractures were found in 34.7%. The treatment time was ≤6 hours in 67.5%, and 203 patients received drug treatment, i.e., 49.7%. Conclusions: Trauma emergencies constitute, by their frequency and seriousness, a real public health problem in Africa in general and in Guinea in particular.

Parameters of Conversion from Temporary External Fixation to Internal Fixation in Open Fractures in Adults

Background Open fractures often have extensive soft-tissue damage requiring multiple procedures such as debridement, soft-tissue coverage, and definitive fixation through the cooperative work of orthopedic and plastic surgeons. Combined treatment for both the fracture and soft-tissue. Patients obtain many benefits from early fixation. Early stabilization facilitates patient mobility and alleviates pain and discomfort. Aim of the Work Systematically reviewing available evidence from published articles to assess points of conversion from this temporary external fixation to internal fixation in open fractures. Patients and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of the interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The moderate negative correlation between CRP and duration of conversion from EF to IF is probably because the downward trend of CRP from the peak value was considered one factor in the timing of conversion to IF, Strategy to perform definitive IF as early as possible resulted in 91% of patients undergoing definitive IF within 3 weeks after injury. In addition, this strategy is described to be beneficial for early soft-tissue repair with low infection rate. Subsequent conversion to ORIF can safely be performed once the patient is hemodynamically and systemically stable and any local soft-tissue injury has resolved, union rate of 91%, an infection rate of 16% and one fixation failure. All the infections occurred in open fractures, of which 75% were Gustilo grade III. Conclusion In conclusion, temporary external fixation for open fracture of the lower limb followed by conversion to internal fixation, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with open fracture. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection.

Posterolateral Plate vs. Lateral Plate in Fixation of Weber B Ankle Fractures. A Systematic Review/Meta-Analysis

Introduction Ankle fractures represent 10% of all fractures making it the second most common lower limb fractures after hip fractures. Danis-Weber classification describes the injury based on the location of the lateral malleolar fracture as type A, B and C. Management of type B ankle fracture is often surgical through open reduction and internal fixation by plate and screws. The plate can be positioned laterally or postero-laterally. Aim of work To compare between posterolateral plate versus lateral plate in management of DanisWeber type B fibular fracture. Materials and methods A systematic review and meta-analysis in which search strategy done from 2000 to 2020. This study is done on 4 articles with total number of participants 333. The outcomes of interest are operative outcome, functional outcome measured by AOFAS and Olerud and Molander scoring system, complication rates outcome. Results Posteo-lateral plate is superior in less hardware irritation. Regarding operative timing, wound infection, screw loosening and functional outcomes both techniques are comparable with no statistically significant difference. Conclusion Both techniques are comparable with no stasticially difference regarding operative time, wound infection, screw lossening and functional outcomes. However, fixation of lateral malleolar fracture by posteo-lateral plate is superior in less hardware irritation.

Lower Limb Fractures in the Elderly: Challenges and Perspectives for Optimal Care

This article provides an in-depth examination of complex lower limb fractures in orthopedic and traumatology surgery among the elderly population. It highlights the rising incidence of these fractures, particularly in the elderly, emphasizing the importance of associatedrisk factors. The article explores current surgical approaches for fixation and rehabilitation of these fractures, while presenting emerging techniques under development, such as robot-assisted surgery and customized implants. The significance of a multidisciplinary approach in care, involving geriatricians, physiotherapists, and nurses, is emphasized to enhance outcomes and reduce postoperative complications. Lastly, the article underscores the importance of awareness and prevention, highlighting initiatives to reduce falls among the elderly andimprove bone health.

Survival analysis in nonagenarian patients with non-hip lower limb fractures.

The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65, and over 0.5 million over the age of 90. The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons. To report the fracture incidence, survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre. Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database. A retrospective evaluation performed for fracture incidence, treatment, length of hospital duration and mortality at 30-d, 1-year and 2-year. Thirty fractures (28 patients) were identified, twenty-four fractures were treated with surgery (mean age 93 years SD ± 2.59) and 6 managed conservatively (mean age 94 years SD ± 2.07). The mean length of the hospital stay was 18.2 d for both groups. The 30-d, 1-year and 2-year mortality risks were 1/23, 6/23 and 9/23 (4%, 26% and 39%) in the surgery group and 0/5, 1/5 and 2/5 (0%, 20% and 40%) in the conservative group, with no evidence for a difference between the two groups at any time point. Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively. Patients with fewer comorbidities and admitted from their own home were offered surgery.

Radiological and Functional Outcomes and Associated Factors After Secondary Intramedullary Nailing Among Patients With Open Fractures of the Lower Limb.

Background Open fractures of the lower limb are serious injuries caused by high-energy trauma that can lead to long-term disability. Initial treatment includes wound debridement, fracture reduction, and external fixation to stabilize bone fragments. Secondary nailing, a surgical technique to provide additional stability, has been shown to promote early mobilization and improve fracture alignment. However, there is a lack of consensus on the optimal timing and technique for secondary nailing. This study aims to evaluate the functional and radiological outcomes of patients who undergo secondary nailing for open fractures of the lower limb. Methods The study was a hospital-based prospective study of 53 patients who underwent secondary nailing for open fractures of the lower limbs. Patients aged 18 years or older, with Gustilo-Anderson classification grades 1, 2, or 3 A and B, who underwent wound debridement and external fixator application, followed by conversion to secondary intramedullary nail fixation between January 2019 and December 2021 were included in the study. The primary outcome measures were functional and radiological outcomes at follow-ups, assessed using the Lower Extremity Functional Scale (LEFS) and Radiographic Union Scale for Tibia fractures (RUST) score. Data were collected prospectively and analyzed using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY). Descriptive statistics were used to summarize patient demographics and injury characteristics, and the Student's t-test and analysis of variance (ANOVA) were used to compare continuous variables between groups. The study had a final analysis of 39 patients. Results The study reports the baseline characteristics, radiological, and functional outcomes of 39 patients who underwent secondary nailing for open fractures of the lower limb. The majority of the fractures occurred in the tibia (71.8%), with most classified as grade 3 (A and B) (69.2%). At the end of the six-month period after secondary nailing, 74.4% of the fractures had a union. Radiological and functional outcomes showed significant improvement after undergoing secondary nailing. Gender and age group did not have a significant association with the radiological outcome, while the time interval between external fixation and secondary nailing was significantly associated with the radiological outcome at six weeks and threemonths. Conclusion According to a study, secondary nailing is effective in managing lower limb open fractures with good radiological and functional outcomes. The time interval between external fixation and secondary nailing affects radiological outcomes, with longer delays leading to lower RUST scores. Orthopaedic surgeons should consider this factor when planning surgical management. Larger sample sizes and more extended follow-up periods are needed to confirm findings and evaluate the effect of other variables on the outcome.

Development of an experimental method for well-controlled blast induced traumatic limb fracture in rats

Heterotopic ossification (HO) is a consequence of traumatic bone and tissue damage, which occurs in 65% of military casualties with blast-associated amputations. However, the mechanisms behind blast-induced HO remain unclear. Animal models are used to study blast-induced HO, but developing such models is challenging, particularly in how to use a pure blast wave (primary blast) to induce limb fracture that then requires an amputation. Several studies, including our recent study, have developed platforms to induce limb fractures in rats with blast loading or a mixture of blast and impact loading. However, these models are limited by the survivability of the animal and repeatability of the model. In this study, we developed an improved platform, aiming to improve the animal’s survivability and injury repeatability as well as focusing on primary blast only. The platform exposed only one limb of the rat to a blast wave while providing proper protection to the rest of the rat’s body. We obtained very consistent fracture outcome in the tibia (location and pattern) in cadaveric rats with a large range of size and weight. Importantly, the rats did not obviously move during the test, where movement is a potential cause of uncontrolled injury. We further conducted parametric studies by varying the features of the design of the platform. These factors, such as how the limb is fixed and how the cavity through which the limb is placed is sealed, significantly affect the resulting injury. This platform and test setups enable well-controlled limb fracture induced directly by pure blast wave, which is the fundamental step towards a complete in vivo animal model for blast-induced HO induced by primary blast alone, excluding secondary and tertiary blast injury. In addition, the platform design and the findings presented here, particularly regarding the proper protection of the animal, have implications for future studies investigating localized blast injuries, such as blast induced brain and lung injuries.

Parental Postoperative Pain Management Perceptions, Attitudes, and Practices in Pediatric Limb Fractures

BackgroundPost-surgical pain in children is common, severe, and inadequately controlled. An effective model should involve the participation of parents. AimsTo investigate parental perceptions, attitudes, and practices in postoperative pain management in children with limb fractures and analyze the factors affecting parental practices. DesignThis was a descriptive cross-sectional study. SettingsResearch was conducted at a tertiary Children's Hospital Affiliated with Soochow University. ParticipantsParents whose children (age, 6–18 years) underwent orthopedic fracture surgery between January 1, 2020, and August 31, 2020, were recruited using purposive sampling. MethodsThe parents were asked to complete self-report questionnaires: “Pain Management Knowledge and Attitudes Questionnaire” and “Parents’ Use of Pain Relief Strategies Questionnaire.” The Wong–Baker Faces Scale was used to measure pain intensity in children. The Mann–Whitney U test, Kruskal–Wallis H test, and correlation and regression analyses were used for statistical analyses. ResultsData of 180 parents were collected. Of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents’ use of pain-relief strategies was related to their general attitudes, knowledge, and sex. ConclusionsMost parents had low-to-moderate scores for perceptions and general attitudes toward children’s postoperative pain management, and use of pain relief strategies. Moreover, they lacked knowledge of and had negative attitudes toward pain assessment and analgesics, which significantly impacted their practices. Clinical ImplicationsClinical pediatric nurses should provide appropriate support for the entire family of the child. Moreover, to enhance parental practices, they should develop targeted parental education programs for pain management, particularly regarding pain assessment tools and pain medications.

A Cross-sectional Study on the Prescription Pattern of Undenatured Collagen-II in Bangladeshi Patients

Numerous clinical and experimental studies have shown that individuals with a variety of orthopedic diseases can get benefit from the undenatured form of type II collagen (UC-II). It has proved its efficacy and long lasting effectiveness for several orthopedic patients throughout different countries in the world. But in Bangladesh it is not frequently prescribed yet. Therefore, we made the decision to conduct a survey-based study to determine the number of patients prescribed with UC-II under which pathological conditions and to what extent they have got relief from their joint associated ailments. To conduct the study, we visited the orthopedic department of various hospitals in Bangladesh and with consent from patients we collected pictures of prescriptions as well as got overview regarding their complications. We gathered photographs of 252 prescriptions from orthopedic department patients, among which only 31 patients were prescribed with UC-II. According to this study, 40.47 , 32.54 , 15.47 , 9.12 and 2.38 % of patients were over the age group of 60 , 50 , 40 , 30 and 20 - years respectively. We found that a range of individuals with various orthopedic problems such as osteoarthritis, spondylosis, right tibial plateau, paresthesia in right upper limb and various bone fractures were advised with UC-II. However, we discovered only in 12.30% of prescriptions that the doctors prescribed UC-II, indicating this is a less common practice in Bangladesh in spite of its huge potential to recover joint pain associated complications. Bangladesh Pharmaceutical Journal 26(2): 157-161, 2023 (July)

Comparison of Nalbuphine Versus Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Orthopedic Lower Limb Surgeries: A Randomized Controlled Double-Blind Study.

Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-threeAmerican Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test. Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects. Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.

Ultrasound guided suprascapular and supraclavicular nerve block in combination with continuous perineural brachial plexus block for operative management of upper limb multiple fractures: a case report

We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.

Minimally invasive treatment of upper limb fractures

Minimally invasive treatment of upper limb fractures

Retracted: Posterior Lumbar Plexus Block Anesthesia for Elderly Patients with Lower Limb Fracture.

[This retracts the article DOI: 10.1155/2022/8494796.].

Ekman-Lob Stein Syndrome in Iraq: An Educational Article and Expert Opinion

Background: Ekman-Lobstein syndrome is a genetic bone disorder that has also been called Lobstein syndrome, Vrolik syndrome, Fragilitas ossium, Glass-bone disease, and Brittle bone disease and 0steogenesis imperfecta. The condition is not a single disease, but a variety of disorders or types of variable severity. We have previously described a case of EkmanLobstein syndrome in a boy with blue sclerae that was most likely had type 1 of the syndrome according to David Owen Silence and colleague’s classification. Materials and Methods: The case of two sisters with chronic deforming bone disease from Maysan Governorate in the south of Iraq, whom were observed during May, 2023 is described. Results: The older thirteen years old sister has significant bowing of the limbs that markedly reduced her mobility, and she was using a wheelchair. The younger sister was at about the age of four and half years, and she had less severe bowing and she was still able to walk. Both girls had history of fracture of the upper limb. Both girls received the diagnosis of refractory rickets and were treated with vitamin D and calcium supplements. Both sisters have no blush sclera. The younger sister laboratory tests performed during May, 2023 showed normal serum calcium of 9 mg/dL and normal serum phosphorus of 5.16 mg/dL. However, the alkaline phosphatase was high at 164 u/l (Normally less than 140 u/l). Radiographs of both sisters showed no rachitic changes, but showed changes consistent with diagnosis of Ekman-Lobstein syndrome. Conclusion: This paper documented the occurrence of another type of Ekman-Lobstein syndrome in Iraq without blue sclerae, in addition to type 1 (David Owen Silence and colleagues’ classification) which we have previously reported. The current expert opinion suggests that bisphosphonates have been shown to be beneficial in improving the condition and therefore should be considered as the treatment of choice.

Epidemiology of traumatic spinal fractures in patients aged 50 years or less at a center in Saudi Arabia from 2005 to 2016

Background: We retrospectively reviewed traumatic spinal fractures (TSFs), including their mechanisms of injury and associated injuries in patients aged ≤50 years admitted to our center over a period of 11 years. Our secondary objective was to investigate whether spine injuries have decreased since the introduction of new transportation-related legislation applications. Methods: Between 2005 and 2016, all patients admitted to the hospital due to TSFs, including cervical, thoracic, and lumbar spinal fractures, who were aged ≤50 years were included in this study. Patient demographics, mechanism of injury, associated injuries, hospital stay duration, treatment, complications, and mortalities were reviewed and analyzed. Results: Altogether, 373 patients (81% male; 19% female; median age, 28 years) were included in the study, and 579 spinal fractures were identified. The lumbar spine was the most affected part. The most common injury mechanism was motor vehicle accidents (MVA) (69.7%), followed by falls (26.8%). Neurological injuries were detected in 9.4% of patients. Associated injuries were observed in 45.3% of patients, and 33.6% of patients were surgically treated. Thoracic injuries and lower limb fractures were the most common injuries, and the postoperative complication rate was 3.9%. Conclusions: Although there was a significant decrease in TSFs after the speed control legislation over the study period, MVA and falls remained the most common causes of spinal injuries. Associated injuries, operated patients, and female sex were all associated with a prolonged hospital stay.

Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort.

Waist circumference (WC) is a stronger risk factor of metabolic disorders than body mass index (BMI), but whether it holds true for fracture risk prediction remains unclear. We aimed to evaluate relationships between WC and fracture incidence within BMI categories and evaluate whether BMI modifies these relationships. Men and women aged 40-70years from the CARTaGENE cohort were divided by BMI category at baseline: normal weight, overweight, and obesity. Incident fractures were identified over 7years via linkage with healthcare administrative databases. Cox proportional hazard models estimated the relationships between WC and incident fractures at any site and by skeletal site within each BMI category. Results are reported as adjusted hazard ratios (95% confidence intervals) per 10cm increase in WC. Effect modification was evaluated qualitatively by comparing relationships between BMI categories. Of the 18 236 individuals included, 754 sustained a fracture. Significant relationships were found between WC and distal lower limb fractures in the normal (1.25 [1.08, 1.45]) and overweight (1.28 [1.07, 1.52]) BMI categories, but not in the obesity category. In the overweight category, we found an increased risk of distal upper limb fractures with increasing WC (1.49 [1.04, 2.15]). No significant relationship was observed regarding WC and fracture risk at any site or major osteoporotic fractures. An effect modification of BMI on the relationships between WC and distal lower limb fractures was observed. WC provides both independent and additive information to BMI for the identification of individuals at risk of obesity-related fractures.

PREVAILING TRENDS OF MORPHOLOGICAL INJURIES IN DRIVERS AND PASSENGERS OF JEEPS AND SUVS IN FATAL ACCIDENTS

Forensic medical examination of corpses in traffic accidents is an important area of research in the field of road safety. Vehicle collisions often lead to tragic consequences, and are a significant part of the causes of violent deaths in the interior of cars. Despite constant changes in the design features of modern cars aimed at improving safety, mortality remains significant.
 The study is aimed at studying the injuries of the driver and passenger in the cabin of jeeps and SUVs in a head-on collision, taking into account the features of the car design and the mechanisms of force transmission to the body of the passengers.
 Aim of the work. Study, analysis and systematization of injuries typical for drivers and passengers in the interior of jeeps and SUVs in frontal collisions with partial overlap.
 Materials and methods. 168 acts of traffic accidents with a fatal outcome were analyzed, from which the injuries of the driver and passenger during a frontal collision in the cabin of jeeps and SUVs were considered.
 During the research, the following methods were used: system-structural analysis, observation, comparison and description. Also, a forensic examination of injuries was carried out for each case. Statistical analysis included the use of descriptive statistics and multivariate analysis to test the null hypothesis.
 Results. The analysis of injuries to the driver and passenger in the cabin of a modern J-class car showed that in cases of fatal auto trauma, the following injuries occurred, which were more typical for passengers compared to drivers: front and rear torso injuries, soft tissues of the right leg, bone fractures lower limbs on the right and left, pelvic fractures on the right and left, kidney damage, ruptures of the spleen and lungs.
 Conclusions. In cases of fatal traffic accidents in frontal collisions in the interior of jeeps and SUVs, the following injuries occurred, which were more typical for passengers compared to drivers: front and rear torso injuries, soft tissues of the right leg, bone fractures of both lower limbs, right and left pelvic fractures, kidney damage, ruptures of the spleen and lungs.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture.

To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

Oral Health Status Using the Revised Oral Assessment Guide and Mortality in Older Orthopaedic Patients: A Cross-Sectional Study.

Orthogeriatric hospitalised patients with fractures of the lower limb constitute a vulnerable population with increased risk of morbidity, polypharmacy, and mortality as well as impaired oral health. The aim of this cross-sectional study was to investigate whether any relationship existed between oral health issues in older orthopaedic patients and mortality. The study population consisted of older orthopedic patients emergently admitted to a hospital in southern Sweden due to mainly fractures of the hip. Their oral health at admission was assessed by trained nurses using the revised oral assessment guide (ROAG), as well as examined by dental hygienists. Medical and demographic data were collected from medical records and mortality from the national population registry. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Data were analysed using foremost dichotomized data derived from mean values and then processed using multiple logistic regression adjusted for identified probable confounders. Of the 187 study patients (≥65 years) with a mean age of 81 (SD 7.9) years, 71% were women, mean CCI score was 6.7 and 90-days mortality 12.3%. Oral health issues (ROAG >8, 73%) consisted mainly of problems with teeth/dentures (41%), tongue (36%), lips (35%), and saliva (28%). In patients with any oral health impairment (ROAG >8) the 90-days mortality was significantly increased (p=0.040), using logistic regression analysis adjusted for age, gender, comorbidity, and use of ≥5 drugs. In patients with a ROAG score ≥10 (≥mean) the association remained at 90-days (p=0.029) and 180-days (p=0.013). Decayed teeth were present in 24% and was significantly associated with ROAG >8 (p=0.020). The main finding of this study was a possible relationship between oral health impairment at admission and early mortality in orthogeriatric hospitalised patients. The opportunity to identify their oral health problems can help improving further care planning and care.

Risk Factors Associated with Fatality in Road Traffic Accidents in Lahore

Background: The objective of the study was to analyze the epidemiology of risk factors associated with fatal road traffic accidents in Lahore-Punjab, Pakistan. Methods: An Analytical cross-sectional study was conducted in Lahore, between July 2019 and September 2019. Data of 290 road traffic accidents was collected from office of Rescue 1122. To collect data systematic Random Sampling technique was used. Data was collected on preformed pretested questionnaire. Data was entered and analyzed in SPSS version 23. Chi-square test of significance was applied, p-value of less than 0.05 was considered as significant. Results: Mean age of victims of RTA was 31.4±14.7. About 28.3% of the total accidents were observed among 20-29 years age group. Out of total 290 victims, 239 (82.4%) were males. Majority, 228(78.6%) of the accidents involved Motorcyclists. Significant association was found between fatal accidents and injury to head (p-value = 0.00), Concussion (p-value=0.00), with No fractures of limbs (p-value= 0.04) and critical condition of victim (p-value=0.00). Conclusion: Road Traffic Accidents were more common among males of 20-29 years age. Most of the victims were motorcyclists. Head Injuries, concussion and critical conditions of victims has significant association with fatality.