High-velocity Accidents Research Articles

Frontonasal Trauma - A Challenge for Maxillofacial Surgeons

Traumatic isolated frontonasal injuries are seldom reported in literature as they are generally seen along with panfacial, high velocity accidents. A peculiar case, in which the patient reported with an isolated frontonasal injury due to a freak accident involving a hoe is presented here. After surgical intervention, titanium plates were used to fix the frontal bone. The sinus lining was preserved and the nasal bone was reduced and immobilized. The patient was discharged and kept on a weekly follow up.

Childhood Obesity and Low-Velocity Knee Dislocation in a Fifteen-Year-Old Girl

According to the 2007-2008 National Health and Nutrition Examination Survey (NHANES), an estimated 17% of children and adolescents between the ages of two and nineteen years are overweight1. The survey data indicated that there was an increase in the prevalence of obesity in children and adolescents in the United States during the years 1976 through 1980 and the years 1999 through 2000. Among two-year-olds to five-year-olds, the percentage has increased from 5% to 10.4%, and among six-year-olds to eleven-year-olds, from 6.5% to 19.6%1. The comorbidities often associated with obesity include diabetes, atherosclerosis, sleep apnea, and coronary artery disease. Musculoskeletal injuries are less often associated with obesity. Minor trauma in overweight individuals can cause serious injuries similar to those caused by high-velocity accidents, with the most notable injury being knee dislocation2. These injuries have been documented mostly in obese adults; however, to our knowledge, the youngest person to have sustained a low-velocity knee dislocation was a nineteen-year-old3. In this report, we document a fifteen-year-old obese girl who sustained a knee dislocation with serious complications due to a ground-level fall. To our knowledge, this is the youngest patient with this injury to be reported in the literature. The patient and her parents were informed that data concerning the case would be submitted for publication, and they consented. A fifteen-year-old obese girl (weight, 113 kg; height, 167 cm; body-mass index, 40.5 kg/m2) injured her right knee after falling over a friend’s leg while playing at school. On initial evaluation at an outside institution, she was noted to have posterior dislocation of the right knee (Figs. 1-A and 1-B) and no pulse in the involved extremity. The knee was reduced with traction, but the limb remained pulseless. The patient was transferred to the regional pediatric …

Endovascular treatment of acute traumatic thoracic aortic injuries: A retrospective analysis of 20 cases

We report our 10-year experience in the endovascular treatment of acute traumatic thoracic aorta rupture at the Hospital Clinic. We reviewed 20 patients with an acute traumatic thoracic aorta lesion treated with a thoracic endograft between August 1997 and July 2007. All patients had multi-trauma resulting from high-velocity accidents or accidents with great impact. The diagnosis of aortic injury was made on a clinical basis and conventional imaging, confirmed by computed tomographic angiography. The following parameters were studied: age, sex, type and site of the lesion, type of endovascular graft, endovascular operation time, length of stay in the intensive care unit, length of stay in the hospital, immediate and perioperative complications, and mortality. Follow-up data were recorded, consisting of clinical visits, computed tomographic angiography, and plain chest radiographs at regular intervals (3, 6, and 12 months and every subsequent year). The mean follow-up was 58 months. All endovascular procedures were technically successful, and the mean operating time for the endovascular procedure was 74 minutes (range, 55-130 minutes). We recorded an external iliac lesion during the procedure as an unique immediate complication, and it was corrected by an iliofemoral bypass. The only perioperative death (perioperative mortality rate of 5%) was unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during the follow-up. Postoperative data showed no severe endovascular graft- or procedure-related morbidity. We recorded 2 cases of stent fracture, diagnosed by chest radiograph and computed tomographic angiography, without clinical impact or signs of endoleak. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Nevertheless, long-term follow-up data are necessary to assess the overall durability of this procedure, considering the young age of these patients. The long-term follow-up results will determine whether endovascular treatment should replace open surgery as first-line therapy in thoracic aortic injuries.

Isolated radial head dislocation, a rare and easily missed injury in the presence of major distracting injuries: a case report

High velocity accidents can lead to major injuries – long bone fractures, abdominal trauma, pelvic fractures and chest injuries. These injuries can act as distracting factors during the initial assessment of a polytrauma patient and innocuous but significant smaller injuries can be missed. We present a rare case of isolated anterolateral radial head dislocation in a polytrauma patient.

Nomenclature of Frontobasal Trauma: A New Clinicoradiographic Classification

High-velocity accidents cause significant injury to the cranial and facial skeleton. Frontobasal fractures include fractures of the upper third of the face and anterior skull base. The pattern and classifications of these fractures are poorly understood at present. The authors have attempted a new comprehensive classification based on detailed clinicoradiographic evaluation. A prospective study was undertaken in a tertiary care hospital in 1 calendar year (July of 2000 to June of 2001). All 63 patients with frontobasal fractures had detailed clinical and radiographic evaluation with plain radiographs and high-resolution computed tomographic scan. The fractures were classified as frontal, basal, and combined. Areas were separated as central (designated type 1) and lateral (designated type 2) to differentiate the pattern in the sagittal plane according to the site of impact. Combined fractures involving both central and lateral areas were designated type 3. These could be further classified into unilateral or bilateral or pure or impure, depending on the absence or presence of midfacial fractures. The fractures were subdivided into nine types considering the whole lateral and anteroposterior extents of the frontobasal region. The most common was the combined frontobasal type (30.16 percent). We found the pure type in 38.1 percent (24 of 63) and the impure type in 61.9 percent (39 of 63) of patients. Cerebrospinal fluid leaks occurred more commonly in impure types of frontobasal fracture. Blunt trauma leading to closed frontobasal fracture was seen in 35 patients. Penetrating trauma with open fractures was found in 28 patients and cerebrospinal fluid leak through the wound was seen in six of them. The new comprehensive classification clearly defines the anatomical areas within the frontobasal region, the nature of injury, and its association with midfacial injuries, and is helpful in planning the approach to their exposure in surgery.

THE EPIDEMIOLOGY OF KNEE DISLOCATIONS

The traumatically dislocated knee can be a devastating injury; fortunately, it is uncommon. More attention is being given to the treatment of knee dislocations as the capability of ligamentous reconstruction increases. Great treatment advances are anticipated as this interest grows and outcomes are evaluated. Nonetheless, the complications of this injury, including loss of limb, still occur from the missed diagnosis of a knee dislocation. MR imaging and other technological advances do not relieve the clinician of the responsibility for performing a thorough physical examination. Suspicion of an associated neurovascular injury must always be high. To a certain degree, prevention of this injury may be possible in the high-velocity accidents that occur with motor vehicles and in industry. Advancement in vehicular designs, with specific attention to airbags, dashboards, and firewalls, needs to be made to reduce the incidence and magnitude of lower extremity trauma in motor vehicle accidents. Seat belts remain the most effective restraint in the prevention of lower extremity trauma in the motor vehicle.

Diffuse axonal injury without direct head trauma and with delayed onset of coma

A 16-year-old female was involved in a jet ski (water craft) accident resulting in bilateral lower extremity fractures but no loss of consciousness or any other evidence of head trauma. Thirty hours later she became comatose. Magnetic resonance imaging was consistent with diffuse axonal injury. She recovered after several weeks without any clinical sequelae. This patient demonstrates an unusual example of diffuse axonal injury without direct head trauma and with delayed onset of symptoms. The authors recommend that patients involved in high-velocity accidents, even without immediate evidence of head injury, be observed for signs of diffuse axonal injury.

The epidemiology of fractured femurs and the effect of these factors on outcome

We have analysed 250 cases of fractured shaft of the femur with the objective of highlighting any preventative measures and anticipating morbidity associated with cause and type of injury. The younger patients typically injure themselves as pedestrians, motorcyclists and bicyclists in Summer. The older patients tend to have falls in late Summer and Winter. The outcome varies depending on the cause, type and age of the injured person. The greatest morbidity was found in high-velocity accidents involving motorcyclists, pedestrians and car accidents. Knee flexion is a particular problem with these injuries and we are currently using continuous passive motion in conjunction with a continuous opiate infusion where this is likely to be a problem. The results also suggest that the mechanism of injury and its possible prevention, particularly in motorcycle design, could be as important as the type of treatment. Elderly females following falls also form a distinct group, suggesting that osteoporosis is a major factor with the best outcome associated with treatment by internal fixation. We feel that age alone should not be a reason for exclusion from intramedullary fixation and this merits further study.

Facial Fractures: Associated Injuries and Complications

JG Thomson, HC Brown, RA Brown, DM Fleiszer. Facial fractures: Associated injuries and complications. Can J Plast Surg 1994;1(4):160-165. The forces necessary to produce a facial fracture are often high enough to cause other severe, life-threatening injuries. Despite this knowledge, little is known about the frequency or nature of these injuries. A retrospective chart review was performed on 162 facial fracture patients for associated injuries and complications. These patients were divided into high velocity (n=95) and low-velocity (n=67) groups based on the mechanism of injury, and were compared with a group of 346 multiple trauma patients who did not sustain any facial fracture. Those patients involved in high-velocity accidents had a significantly higher proportion of multiple facial fractures (40%), presence of associated injury (84%), complication rate (38%), mortality rate (9.5%), mean hospital stay (45 days), and mean trauma score (20.1±1.3) when compared with patients in low-velocity accidents (10%, 12%, 10%, 4.3 days and 4.7±0.6, respectively). Although high-G facial bone fractures were more frequent in high-velocity accidents, high-G fractures were not an independent indicator of the severity of injury as measured by the trauma score. The most significant indicator of severity of injury was the mechanism of injury. Pulmonary (15%), cerebral (11 %), septic (7%), abdominal (7%) and cardiac (2%) complications after high-velocity injuries were more frequent than previously reported. Although cervical spine injury has traditionally been associated with facial fractures, the results of this study demonstrated that spinal injury can occur at any vertebral level, and was equal in frequency in patients with and without facial fractures. Statistical analysis of occupant restraint revealed that there was no significant difference between the numbers of patients wearing their seat belts (11) and those not using them (12), the proportions with high-G, low-G, or multiple facial fractures, the incidence of head injury or other associated injuries, the trauma score, and the times spent in the surgical intensive care unit and hospital. Although the lack of significance is probably attributable to the low documentation of seat belt use, the question of the efficacy of seat belts in preventing facial fractures and associated injuries is raised. Patients with facial fractures had a significantly higher mean trauma score (27.9±1.4) and incidence of head injury (54%) compared with patients without facial fractures (23.2±0.7 and 11%, respectively). The surgical treatment of this group of facial fracture patients was analyzed.

Treatment of Ipsilateral Fractures of the Femoral Neck and Shaft

We studied 43 patients with ipsilateral femoral shaft and femoral neck fractures who had dynamic hip screw fixation alone or in combincation with dynamic compression plate. All patients except two were diagnosed early; 37 patients had other associated injuries. There were 41 males and two females. The follow-up ranged from eight months to four years (mean 2-1/2 years). Six patients were lost to follow-up. Fracture of the neck of the femur healed in all 37 patients. Four patients had delayed union and two patients developed nonunion of the shaft of the femur. The aim of this paper is to show our experience and results using one technique for the treatment of such fractures.

An effective surrogate for impact studies

Nineteen unembalmed (fresh) cadavers were used in 21 experiments to test restraint systems in automobile impact studies. Some were mounted in a rearward firing sled; others were placed in standard cars during collisions. Prior to and after testing, each cadaver was evaluated. After each experiment a postmortem examination was performed. High-speed registering cameras (1,000 to 2,000 frames per second) were used and multiple telemetric recordings were made. The radiographic and pathologic changes were similar to those seen in patients following high-velocity accidents. Results were compared with those of car accident victims admitted dead on arrival to one of our hospitals. This study is a progress report. The results are being used to improve existing restraint systems and to evaluate experimental models.

The management of complex forearm fractures

This paper describes the management, complications and results of 6 complex forearm injuries sustained in high velocity accidents. The value of combining established concepts with modern advances in the treatment of such injuries is discussed.

Barton??s Fractures-Reverse Barton??s Fractures

Anterior and posterior marginal fracture dislocations of the distal radius are unusual injuries, both of which are called Barton's fracture in the current world literature. Barton's original description delineates only the posterior marginal injury. An attempt is made to clarify the nature of these injuries by a complete review of the literature and a study of the clinical experience at UCLA Hospital from 1972 through 1975. Ten anterior and five posterior marginal fractures were treated during that period of time, constituting 2.3 per cent of all distal forearm fractures. Fractures in males typically stemmed from high velocity accidents in the younger age group and were associated with significant additional injuries. The injuries in females resulted from simple falls, generally in the older age group. Eight fractures were treated open and seven closed without complications; treatment results have not been determined yet. Eponym descriptions should be discontinued and replaced with a lucid anatomically descriptive classification such as anterior and posterior marginal fracture-dislocations of the distal radius.