High Fall Injury Research Articles

Treatment of spinal burst fractures with pedicle screw fixation at high altitude area

According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions, to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures. From August 2018 to December 2021, 12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique, including 7 males and 5 females;aged 29 to 54 years old, with an average of(42.50±7.95) years old;6 cases of traffic accident injury, 4 cases of high fall injury, 2 cases of heavy object injury;2 cases of T11, 4 cases of T12, 3 cases of L1, 2 cases of L2, and 1 case of L3. In the operation, screws were first placed in the upper and lower vertebrae of the fracture, pedicle screws were placed in the injured vertebra, and connecting rods were installed, and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients, and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray. All operations were successful without significant intraoperative complications. All 12 patients were followed up, the duration ranged from 9 to 27 months, with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701, P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085, P=0.000). Three days after operation, Cobb angle was (4.42±1.16)°, and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) °at 9 months after operation, with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found. Under the high-altitude hypobaric and hypoxic environment, the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra, with less bleeding and shorter fixed segments, which is an effective method.

Development of a nomogram to predict surgical site infection after closed comminuted calcaneal fracture

BackgroundCompared with open comminuted calcaneal fractures, less emphasis is placed on postoperative surgical site infection (SSI) of closed comminuted calcaneal fractures. This study aimed to identify the risk factors associated with SSI and build a nomogram model to visualize the risk factors for postoperative SSI.MethodsWe retrospectively collected patients with closed comminuted calcaneal fractures from the Second Affiliated Hospital of Wenzhou Medical University database from 2017 to 2020. Risk factors were identified by logistics regression analysis, and the predictive value of risk factors was evaluated by ROC (receiver operating characteristic curve). Besides, the final risk factors were incorporated into R4.1.2 software to establish a visual nomogram prediction model.ResultsThe high-fall injury, operative time, prealbumin, aspartate aminotransferase (AST), and cystatin-C were independent predictors of SSI in calcaneal fracture patients, with OR values of 5.565 (95%CI 2.220–13.951), 1.044 (95%CI 1.023–1.064), 0.988 (95%CI 0.980–0.995), 1.035 (95%CI 1.004–1.067) and 0.010 (95%CI 0.001–0.185) (Ps < 0.05). Furthermore, ROC curve analysis showed that the AUC values of high-fall injury, operation time, prealbumin, AST, cystatin-C, and their composite indicator for predicting SSI were 0.680 (95%CI 0.593–0.766), 0.756 (95%CI 0.672–939), 0.331 (95%CI 0.243–0.419), 0.605 (95%CI 0.512–0.698), 0.319 (95%CI 0.226–0.413) and 0.860 (95%CI 0.794–0.926), respectively (Ps < 0.05). Moreover, the accuracy of the nomogram to predict SSI risk was 0.860.ConclusionsOur study findings suggest that clinicians should pay more attention to the preoperative prealbumin, AST, cystatin C, high-fall injury, and operative time for patients with closed comminuting calcaneal fractures to avoid the occurrence of postoperative SSI. Furthermore, our established nomogram to assess the risk of SSI in calcaneal fracture patients yielded good accuracy and can assist clinicians in taking appropriate measures to prevent SSI.

Clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture

ObjectiveThis study was designed for the first time to analyze clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture.MethodsThis study retrospectively analyzed 220 older patients with infectious bone nonunion after open tibial fracture. There were 110 patients receiving bone transport technology (Group A) and 110 patients receiving membrane induction technique with antibiotic bone cement (Group B).ResultsThere were 164 male patients and 56 female patients, with an age range of 65 to 71 years and an average age of 67 ± 1.3 years. Traffic accident, high-fall injury and crush injury account for 45.5, 27.7 and 26.8%, respectively. Age, gender, histories, causes and fracture location had no significant difference between the two groups (P > 0.05 for all). Operation time in the Group A was significantly shorter than that in the Group B (P < 0.05). Linear and positional alignment (70.9 vs. 57.3), American Knee Society knee function score (167.7 ± 14.9 vs. 123.8 ± 15.7), Baird-Jackson ankle function score (89.9 ± 3.5 vs. 78.4 ± 4.9), bone healing index (43.0 ± 2.0 vs. 44.3 ± 3.0) and clinical recovery (8.2 vs. 4.5) of patients in the Group A were significantly better than those in the Group B (P < 0.05 for all). Wound infection in the Group A (7.3%) was significantly less than that in the Group B (16.4%; P < 0.05). There were neither a neurovascular complication nor a recurrence of infection in the two groups.ConclusionBone transport technology achieved better knee and ankle joint function recovery and superior bone healing and clinical efficacy than membrane induction technique with antibiotic bone cement, suggesting that bone transport technique is worthy of extensive promotion to improve clinical condition of older patients with infectious bone nonunion after open tibial fracture.

Causes and Characteristics of Children Unintentional Injuries in Emergency Department and Its Implications for Prevention

Background: Child unintentional injuries have become a hot topic worldwide, and substantial regional disparities existed in causes and characteristics. To date, limited data are available to investigate the causes and characteristics of child unintentional injuries from hospitals for children in China.Methods: A cross-sectional study was conducted between January 2017 and December 2018 in Shanghai, China. Patients aged <18 years with an unintentional injury presented to the emergency department were enrolled. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were retrieved from electronic health records (EHRs). Frequencies and proportions of categorical variables and means and SDs of continuous variables are presented. Chi-square test and Student's t-test were used for the comparison between groups, as appropriate. Logistic regression analysis was used to estimate potential risk factors for admission to the hospital.Results: A total of 29,597 cases with unintentional injuries were identified between January 2017 and December 2018, with boys vs. girls ratio of 1.75. Preschool children account for approximately two-thirds of unintentional injuries in the emergency department. A distinctive pattern of mechanisms of unintentional injuries between gender was documented, and sports injury was significantly higher in boys than in girls (10.2 vs. 7.8%). Compared with Canadian Emergency Department Triage and Acuity Scale (CTAS) Grade 3 patients, Grade 2 [odds ratio (OR) = 2.99, 95% CI = 1.93–4.63, P < 0.001] and Grade 1 (OR = 74.85, 95% CI = 12.93–433.14, P < 0.001) patients had higher risk of inhospital admission. For causes of injuries, compared with falling, foreign body and poison had a lower risk of inhospital admission, while transport injury (OR = 1.31, 95% CI = 1.07–1.59, P = 0.008) and high fall injury (OR = 2.58. 95% CI =1.48–4.49, P < 0.001) had a significantly higher risk of admission.Conclusions: There was a significant relationship between age-groups and unintentional injuries between gender, with decreased injuries among girls growing up older. Preventive measures should be taken to reduce transport injury and high fall injury, which had a significantly higher risk of admission.

Arthroscopic Management of Glenoid and Greater Tuberosity Bipolar Fractures.

ObjectiveTo report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation.MethodsFrom December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks，8 weeks，3 months，6 months，1 year after surgery) regularly for at least 1 year. At the follow‐up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed.ResultsOf the 15 patients, there are seven cases of men, eight cases of women; aged 22–66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%–47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow‐up was 38.2 months (range, 12–70 months), and one case was lost to follow‐up. With fractures healing well, almost all patients had a good joint function. At the final follow‐up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T11 level; the mean Constant–Murley score was 94.6 points (range, 70–100 points); the mean ASES score was 94.6 points (range, 79–100 points); and the mean VAS score was 0.4 points (range, 0–2 points). No recurrent instability or re‐dislocation occurred. No patient had revision surgery.ConclusionArthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow‐up time of more than 3 years.

Clinic analysis of 198 elder patients with maxillofacial fracture

The purpose of the study was to analyze the characteristics of elder patients with maxillofacial fracture. We retrospectively analyzed the characteristics of maxillofacial fractures in the elder patients, who were treated from July 2010 to October 2017. The clinical characteristics of the etiology, fracture site, combined injury, systemic disease, and treatment method were analyzed. In the 198 elderly patients with maxillofacial fractures, the male-to-female ratio was 3.95︰1, and the mean age was 66.15 years old. Traffic accident injury (78 patients, 39.39%), fall injury (49 patients, 24.75%), high fall injury (33 patients, 16.67%) were the main factors of maxillofacial fracture in elderly patients. The most frequently observed fracture site was the mandible (120 patients). A total of 60 patients demonstrated associated injuries, in which limb injuries were the most prevalent (28 patients); whereas 66 patients had other systemic medical conditions, in which cardiovascular diseases was the most frequent (50 patients). The main treatment method of 198 patients was rigid internal fixation with small or micro-plates. Falling and traffic accidents are the main factors of maxillofacial fracture in elderly patients. Thus, interference measures should be observed for the prevention of maxillofacial fractures in elderly patients.

A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures.

Management of thoracolumbar fractures remains controversial in the literature. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction. This is a single center, retrospective study. Fifty-five patients presenting with thoracolumbar fractures between January 2012 and December 2015 were analyzed in the study. The levels of fixation were divided in 3 groups: 1 vertebra above and 1 below the fracture (1/1), 2 above and 2 below (2/2), and 2 above and 1 below (2/1). The most common mechanism was high fall injury, and the most common vertebra L1. Burst fractures were the ones with the highest incidence. The 2/2 fixation achieved the best reduction of the fracture, but with no statistical significance. The correction is maintained better by the 2/2 fixation, but there is no statistical difference compared to the other fixations. Insertion of screws at the fracture level did not improve outcomes. The data of this study identified a trend toward better radiological outcomes for fracture reduction and maintenance of the correction in the 2/2 fixations. However, these results are not statistically significant. Future multicenter prospective clinical trials are needed in order to agree on the ideal management and method of fixation for thoracolumbar fractures.

A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures.

Management of thoracolumbar fractures remains controversial in the literature. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction. This is a single center, retrospective study. Fifty-five patients presenting with thoracolumbar fractures between January 2012 and December 2015 were analyzed in the study. The levels of fixation were divided in 3 groups, 1 vertebra above and 1 below the fracture (1/1), 2 above and 2 below (2/2), and 2 above and 1 below (2/1). The most common mechanism was high fall injury and the most common vertebra L1. Burst fractures were the ones with the highest incidence. The 2/2 fixation achieved the best reduction of the fracture but with no statistical significance. The correction is maintained better by the 2/2 fixation but there is no statistical difference compared to the other fixations. Insertion of screws at the fracture level did not improve outcomes. The data of this study identified a trend towards better radiological outcomes for fracture reduction and maintenance of the correction in the 2/2 fixations. However these results are not statistically significant. Future multicenter prospective clinical trials are needed in order to agree on the ideal management and method of fixation for thoracolumbar fractures.

Clinical outcomes of endobutton versus traditional screw fixation for distal tibiofibular syndesmosis in ankle fractures

Objective To compare the clinical outcomes for endobutton versus traditional screw fixation of distal tibiofibular syndesmosis in ankle fractures. Methods Sixty-nine cases of ankle fractures accompanied with distal tibiofibular syndesmosis injury hospitalized between November 2012 and November 2014 were reviewed retrospectively. Thirty-two cases (19 males and 13 females) aged (38.1±15.3) years (range, 22-62 years) underwent syndesmosis stabilization with endobutton system (endobutton group), and mechanism of injury was sprain injury in 20 cases, traffic injury in 7 and high fall injury in 5. Another 37 cases (20 males and 17 females) aged(33.9±11.1)years (range, 22-65 years) were managed with traditional screw fixation (tradition group), and mechanism of injury was sprain injury in 22 cases, traffic injury in 8 and high fall injury in 7. According to the Lauge-Hansen classification, all had pronation external rotation ankle fractures. Operation time, manipulation angle, tibiofibular clear space (TBCS), tibiofibular overlap distance (TBOL), complications and final follow-up evaluation of American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were recorded. Results Comparison of endobutton group to tradition group showed no significant differences in operation time [10 min(5-17 min) ∶9 min(4-15 min)], TBOL [(9.1±1.8)mm ∶(8.2±2.3)mm], TBCS [(3.7±0.6)mm ∶(3.6±0.9)mm], total complication rate [6.3% ∶13.5%] and AOFAS score [(89.1±18.5)points ∶(86.6±12.4) points] (P>0.05), but endobutton technique was associated with a larger manipulation angle [(45.8±16.7)° ∶(28.5±5.6)°] and earlier full weight bearing [(6.8±1.6)weeks ∶(10.9±2.7)weeks] than traditional screw fixation (P<0.05). Conclusion Endobutton technique has comparative effect with traditional screw fixation and has advantages such as low demand in fixation angle, early weight bearing and no need for removal of implant. Key words: Ankle injuries; Fracture fixation, internal; Distal tibiofibular syndesmosis

Mini-locking-plate combined with tension band wiring for treatment of comminuted olecranon fracture

Objective To investigate the clinical effect of the mini-locking-plate combined with tension band wiring for fixation of comminuted olecranon fracture. Methods A retrospective review was made on 37 patients with comminuted olecranon fracture fixed using the mini-locking-plate combined with tension band wiring from March 2010 to June 2014. There were 24 males and 13 females, at mean age of 41 years (range, 22-68 years). Fall injury occurred in 22 patients, high fall injury in 8 patients, traffic injury in 4 patients, stick injury in 2 patients and cutting injury in 1 patient. The fracture occurred on the left side in 16 patients and on the right side in 21 patients. Two patients had an open fracture. None suffered from neurovascular injury or elbow joint instability. The duration from injury to operation was 4 to 98 h (mean, 43 h). The elbow function was evaluated according to the Mayo elbow performance score (MEPS). Results Thirty-five patients were followed up for 6 to 26 months (mean, 15 months). Good fracture reduction and flat articular surface were shown on the X-rays. Fracture union was observed in all patients. At the final follow-up, the MEPS ranged from 70 to 100 points (mean, 94 points). Thirty-one patients were rated excellent, 2 good and 2 fair, with the excellent-good rate of 94%. No incision infection or internal fixation failure occurred. Conclusion The procedure is a safe and effective method that allows early functional exercise. Key words: Ulna fractures; Fracture fixation, internal; Tension band wiring

Morphologic studies of high fall injuries

ObjectiveBy studying the mode and morphologic character of high fall injuries on the scene, and exploring the injury situation of different heights, different fall ways and postures, to provide a reference for the forensic identification of high fall injury. MethodsAll the high fall cases were statistically analysed according to their gender, age, ground-touching posture, fall height, site and type of the injury. ResultsAmong 134 high fall cases, 98 were male and 36 were female with the age ranging from 2-71 years (37.6 ±16.9 on average), in which, 10-60 years old group consisted of 110 cases (82%). Most cases fell from windows or roofs (73%) and the touching objects were cement ground or shaft bottom of elevators. Among these cases, head injury was generally serious, followed by chest and abdominal injuries. The morphologic changes depend upon the height, nature, as well as the posture at the point while the body touches the ground. ConclusionMorphologic study of high fall injury assists medicolegal physicians to make correct identifications of the cause and nature of high fall injuries.

Damage control laparotomy in multiple trauma care: a report of 33 cases

Objective To investigate the effect of damage control laparotomy in multiple trauma care. Methods A retrospective review was made on clinical data of 33 multiple trauma cases who received damage control laparotomy from January 2009 to June 2015. Twenty-four cases were males and 9 females, with the age range of 19-68 years(mean, 41.0 years). The trauma causes included traffic injury in 21 cases, high fall injury in 6 cases, falling object injury in 5 cases, and detonator blast injury in 1 case. Injury severity score (ISS) ranged from 14 to 64 points (mean, 27.0 points). All cases presented abdominal injury. Complicated injuries included brain injury in 10 cases, chest injury in 23 cases, and pelvic limb injury in 21 cases. All cases underwent damage control laparotomy, and then temporary abdominal closure after abdomen surgery. Abdominal closure time, intro-abdominal hypertension (IAH) or abdominal compartment syndrome (ACS), related treatment methods, hospital length of stay, and complications were recorded after operation. Results Twenty-nine cases had primary fascial closure 5-12 d after surgery. Four cases were unable to complete definitive abdominal wall reconstruction within the short term, and underwent skin grafting to form planned ventral hernia. Twelve cases developed IAH or ACS, and were cured using intra-abdominal volume increment assisted by vacuum sealing draining (VSD). Hospital length of stay was 21 - 70 d (mean, 31.4 d). There were wound infections in 2 cases of open fractures and abdominal incision infections in 4 cases, but all were cured after debridement plus VSD treatment. Abdominal abscess occurred in 1 case, and was cured by abdominal puncture and drainage. All cases were discharged from hospital smoothly. Conclusion Rational application of damage control laparotomy is a safe and effective treatment method for multiple trauma combined with abdominal injury. Key words: Multiple trauma; Abdominal injuries; Surgical procedures, operative; Second-look surgery

Shortening Osteotomy and Sacro-sacral Fixation For U-shaped Sacral Fractures

Technical note and retrospective first cases study. To present a novel surgical procedure for treating rare and challenging U-shaped fractures of the sacrum. U-shaped fractures of the sacrum are not frequent and usually seen in the context of high energy trauma (high-fall injury). There is no consensus about the therapeutic strategy. When surgery is decided on selected patients, the technique raises several issues for the neural decompression, reduction, and fixation. The L5-S1 mobility has to be sacrificed for most authors. Based on anatomic considerations, the authors present here the original surgical technique they have been using at their institution and a consecutive series of patients. The procedure associates a shortening osteotomy of the sacrum at the site of the fracture and a sacro-sacral fixation. The proposed procedure was simple, safe, and effective. Performing the osteotomy helps in the reduction and allows a short fixation, which spares the mobility of the lumbo-sacral junction.