High-speed Motor Vehicle Accident Research Articles

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy

Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12-30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

Orbital Injuries

SUMMARY The nature of orbital injuries has evolved from the early centuries, when they were often associated with war and assault with a high incidence of mortality and morbidity, to the latter part of the twentieth century, when far more complicated injuries are seen, especially from high-speed motor vehicle acci-dents. Owing to the great advances in medicine and surgery, patients now have a higher rate of survival and also expect a good surgical outcome from their injuries. The management of orbital injuries has been revolutionized by the availability of diagnostic imaging techniques and improved surgical skills, in particular the reconstructive grafting techniques in both hard and soft tissues.

Urethral Injuries in Female Subjects Following Pelvic Fractures

Pelvic fractures resulting from high speed motor vehicle and/or pedestrian-motor vehicle accidents commonly coexist with urethral injuries in the male patient. A review of 130 female patients with pelvic fractures managed at our institution revealed coexisting urethral injuries in 6 (4.6%). Partial urethral disruptions accounted for the majority of morbidity with early removal of the Foley catheter resulting in urinary extravasation, voiding difficulties and vulvar edema. In 3 patients the injury was misdiagnosed, 2 of whom had life-threatening sepsis with necrotizing fascitis as a consequence. Blood at the vaginal introitus was noted in more than 80% of our patients. However, only half of them had a careful vaginal inspection. If this pertinent portion of the physical examination had been performed more than two-thirds of our patients could have been correctly diagnosed. The need for meticulous vaginal examination when blood is located at the vaginal introitus, and the need for careful cystoscopic and/or radiographic evaluations in the female patient with voiding difficulties and/or vulvar edema in the acute post-traumatic phase are stressed.

TRAUMATIC RUPTURE OF THE THORACIC AORTA: TEN‐YEAR EXPERIENCE WITH FOLLOW UP

In the past 10 years, 13 cases of acute traumatic rupture of the thoracic aorta were treated at the Dunedin Hospital. Ages ranged from 16 to 77 years, with a mean of 27 years. Twelve of the patients were involved in high speed motor vehicle accidents and one sustained a fall. The diagnosis was suspected in all 13 cases by a widened mediastinum on plain chest X-ray and confirmed by aortography in all cases. Associated injuries were common. The time interval from injury to surgery ranged from 5 h to 16 days, with a mean of 3 days. A Gott Shunt was used in five patients, seven had partial bypass and one had simple aortic cross-clamping. Mean aortic cross-clamp time was 62 min. Mortality was 15%, both deaths occurring in the bypass group. There were two cases of paraplegia, one occurring in the bypass group and the other in the patient having simple cross-clamping of the aorta. Follow up was possible in 8 of 13 patients and ranged from 3 months to 10 years, with a mean of 39 months. Delayed death due to heart failure occurred after discharge in a 77 year old man 40 days after operation. The long-term results were satisfactory in all survivors, apart from one poorly rehabilitated paraplegic.

Left Ventricular to Right Atrial Septal Defect Secondary to Blunt Thoracic Trauma Diagnosed by Transesophageal Echocardiography

A case report is presented of a 58-year-old man who developed a new holosystolic murmur 4 months after a high-speed motor vehicle accident. Cardiac catheterization demonstrated a left-to-right shunt at the right atrial level. Intraoperative transesophageal echocardiography (TEE) identified and localized a discrete atrioventricular septal defect associated with a shunt from the left ventricle to the right atrium without tricuspid regurgitation, findings that were confirmed after surgical exploration. TEE is recommended for patients with a heart murmur and a history of blunt cardiac trauma, may permit early diagnosis, and may allow surgical repair in selected patients without pre-operative catheterization. (ECHOCARDIOGRAPHY, Volume 8, May 1991)

Hepatic Portal Venous Gas Identified by Computed Tomography in a Patient with Blunt Abdominal Trauma:

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed becaused of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.

Hepatic Portal Venous Gas Identified by Computed Tomography in a Patient with Blunt Abdominal Trauma:

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed because of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.

Traumatic rupture of the thoracic aorta presenting as transient paraplegia

A patient involved in a high-speed motor vehicle accident presented paraplegic to the emergency department. He was noted to have an abnormal chest x-ray and, subsequently, underwent aortography which revealed aortic transection. The patient's paraplegia resolved spontaneously prior to definitive aortic repair hours later. Aortic rupture presenting as paraplegia is a rare association, but one an emergency physician should be cognizant of, especially in the case of blunt or decelerating trauma.

A prospective evaluation of field categorization of trauma patients.

We prospectively evaluated the efficacy of comprehensive field triage in 8,891 trauma patients transported to trauma centers in Dade County, Florida, over a 1-year period ending in September 1986. There were 5,685 males (63.9%) and 3,206 females (36.1%) with a mean age of 32.4 +/- 18.4 years. The overall accuracy for identifying severe injury for the entire group was 30.2%. A Trauma Score less than or equal to 12 was the most accurate predictor of severe injury. Of 669 patients in this group, 617 (92.2%) sustained severe injury and 361 died (54.0%). High-speed (greater than 40 m.p.h.) motor vehicle accident was the most common reason for triage; however, of 2,277 in this group 201 patients (9.0%) had severe injury and four patients (0.2%) died. Only nine deaths (0.9%) occurred in 1,004 patients with penetrating trauma whose Trauma Scores were greater than 12. Of the 8,891 patients 4,791 (53.9%) had moderate to severe injury. The overtriage rate was therefore 46.1% using this field categorization system.

Patterns of high-speed impact injuries in motor vehicle occupants.

Trauma from high-speed motor vehicle accidents is a leading cause of death and disability. Most of these injuries could be prevented if the driver and occupants of motor vehicles wore seatbelts or used other restraining devices. The injuries produced when an unrestrained occupant of a motor vehicle is ejected from that vehicle or impacts on a hostile surface at high speed occur in a reproducible pattern. The types of injuries sustained by drivers and front seat passengers are different and specific enough to allow one to identify drivers and passengers with confidence. Because of severe life-threatening injuries to the central nervous system, and thoracic and abdominal viscera, other serious injuries may be overlooked. Knowledge of the mechanism of injury and the role of the victim (i.e., driver or passenger) should lead to the prompt radiographic evaluation of all areas at risk. Our findings are based on a study of 250 drivers and 250 front seat passengers involved in motor vehicle accidents. We found distinct common injury patterns and radiographic findings in drivers and front seat passengers.

Nasal Avulsion Injuries

The nose is the most frequently traumatized portion of the human face. High-speed motor vehicle accidents and interpersonal violence commonly produce bony pyramid and septal damage and occasional minor soft-tissue damage. Major soft-tissue injuries are much less commonly encountered. Avulsion injuries of this type may involve skin only or the bony and cartilaginous framework as well. The severity of these injuries can range from total avulsion to minor skin loss and anywhere within the spectrum between. My experience is reviewed, management guidelines and options are detailed, and selected cases are presented.

Fractures of the proximal femur : Sikorski J. M., Davis N. J. and Senior J. (1985) The rapid transit system for patients with fractures of proximal femur. Br. Med. J.290, 439

ip fracture is among the most common injuries necessitating hospital admission. Fractures of the hip include fractures of the proximal femur and pelvic ring and may be classified as pathologic or nonpathologic. Regardless of the type of fracture, however, hip fractures can lead to substantial morbidity and mortality. This article discusses the epidemiology of fractures of the proximal femur and the evaluation and treatment of nonpathologic and osteoporotic pathologic proximal femoral fractures. The specific types of proximal femoral fracture discussed are intertrochanteric, femoral neck, subtrochanteric, and greater trochanteric fractures. A future article in this journal will discuss fractures of the pelvic ring, including sacral and acetabular injuries. EPIDEMIOLOGY OF PROXIMAL FEMORAL FRACTURES Between 220,000 and 250,000 proximal femoral fractures occur in the United States each year 1,2 ; 90% of these fractures occur in patients older than 50 years. 1,2 In younger patients, proximal femoral fractures are usually the result of high-energy physical trauma (eg, highspeed motor vehicle accidents) and usually occur in the absence of disease. Intertrochanteric and femoral neck fractures account for 90% of the proximal femoral fractures occurring in elderly patients. 1 Proximal femoral fractures in elderly patients are often pathologic, usually resulting from minimal-to-moderate physical trauma to areas of bone significantly affected by osteoporosis. However, pathologic fractures can occur at any age; typically, these fractures result from low-energy injuries and may be characterized by unusual fracture patterns. 3

Traumatic Dislocation of the Hip

Traumatic dislocation of the hip (TDH) is an absolute orthopedic emergency that is increasing steadily in incidence. Sixty-two to ninety-three percent of reported cases were the result of high-speed motor vehicle accidents in which seat belts were not used. Post-TDH complications and morbidity, particularly femoral head necrosis, are related to the severity of injury, skeletal maturity, and duration of dislocation. Prompt, gentle reduction within 12 hours remains the cornerstone of successful therapy. In a variety of other clinical condition, TDH may be masked, and specific appropriate evaluation is thus necessary to detect the occasionally occult TDH. The regular use of seat belts would virtually eliminate this injury.

Ventricular enlargement after closed head injury.

To study the relationship between enlargement of the cerebral ventricles and neuropsychological deficit after closed head injury (CHI), we measured the area of the lateral ventricles on computed tomographic scans obtained at least 30 days after severe CHI in 32 young adults and a control group of similar age. Enlargement of the lateral ventricles was demonstrated in 72% of the head-injured subjects, as defined by the ventricle-brain percent ratio (VBR). Ventricular dilation was related to the duration of coma after high-speed motor vehicle accidents and to intellectual and memory defects. The VBR may be a useful index of the severity of brain damage in certain categories of head-injured patients.