High Velocity Motor Vehicle Accidents Research Articles

An Evidence-Based Approach to Multi-Ligamentous Knee Injuries.

Multi ligament knee injuries (MLKIs) are highly complex injuries with associated complications and often present with difficult management strategies. MLKIs may affect the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (or posteromedial corner (PMC)), and lateral collateral ligament (or posterolateral corner (PLC)) in addition to other structures including the menisci, common peroneal nerve, and popliteal artery. MLKIs are highly associated with the male sex and are commonly seen in high-velocity motor vehicle accidents and low-velocity sports injuries. Given the multiple planes of movement in the knee and various primary and secondary stabilizers throughout those planes, there is great heterogeneity in an injury pattern and most involve the ACL and PCL. Initial evaluation of this injury includes assessment of lower extremity sensation, distal pulses, and ankle-brachial index (ABI). If vascular compromise is suspected, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are indicated to evaluate the vasculature. As opposed to CTA, MRA offers visualization of the soft-tissue structures that are commonly damaged in MLKIs. Initial management typically includes closed reduction of the knee with subsequent external fixation. Classification systems guide initial assessments; however, further management is unclear and leads the surgical team to decide the best, individualized management option for each patient. As a result, optimal surgical and postoperative treatment options remain complicated, and clinical outcomes remain difficult to predict. The purpose of this review is to consolidate the most up-to-date practices of the diagnostic workup, management, and treatment of MLKIs.

An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries

Background: The objective of the study is to study the Functional outcome and factors influencing the outcome in Floating Knee Injuries. Methods: The study was conducted on patients in department of orthopaedics in S.C.B medical college & hospital from December 2018 to December 2020 who are admitted with Floating Knee Injuries. Detailed history were obtained using study proforma a thorough musculoskeletal examination of both the knees will be done including neuro-vascular status and appropriate radiographs and if necessary CT scan will be done. Collection of Data of the patients were by brief history of injury, systemic and musculoskeletal examination, radiography of thigh with hip and knee and leg with knee and ankle in standard antero-posterior and Lateral View, follow up with radiological and clinical parameters. Clinical follow-up will be done at 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 12 months intervals regarding union of fractured bone, assessment of range of motion of knee, pain on weight bearing. Results: In our study we found males are affected in 33 out of 34 patients (97%), right lower limb was involved in 28 out of 34 patients (82%),majority of the patients were of young age group between 16-40 years (60%),twenty five out of 34 patients (73%) had type I floating knee injury and 9out of 34 (27%) had type II floating knee injury, in most of the cases (70%) surgery was performed within 1 week of trauma. Knee stiffness was more common in older patients, communited fractures, Poor articular reduction. The communited fractures and poor articular reduction correlated significantly with malunion of fractures. Communited fractures were a statistically significant variable for Shortening. Open fractures, communited fractures and segmental fractures are statistically significant for non-union and delayed union. Conclusion: Floating knee injuries are due to high velocity motor vehicle accident. Men are affected more than women. The right-side injury is more frequent than the left side. 55% of patients in this study had an excellent and good functional outcome and 45% of patients had a fair or poor functional outcome. Local complications like wound infection seen in 17.1% of patients A communited fracture is the most common predictor affecting the functional outcomes like Knee stiffness, shortening, and time to union. The other predictors affecting the functional outcomes are poor articular reduction, open fractures, segmental fractures, older age and. The time to union of tibia is more than that of femur. Revision fixation for tibial fractures was more frequent than femoral fractures. Keywords: Floating knee, Knee injury, Functional outcome

A Patient With Traumatic Upper Eyelid Ectropion and Their Management by Canthopexy

Upper eyelid ectropion is rare. When it does occur, the cicatricial subset of upper eyelid ectropion is its most common manifestation. Due to its rarity, little has been published regarding its treatment. Herein, we present the case of a 27-year-old patient who suffered significant left sided facial trauma in a high-velocity motor vehicle accident, resulting in a soft tissue defect in the left lateral supra-orbital region, including loss of the lateral half of the left eyebrow. The defect was left to heal by secondary intention causing severe cicatricial upper eyelid ectropion. Several reconstructive techniques were subsequently utilized including recreating the defect and replacing like with like tissues according to the facial sub-units. Right sided upper eyelid skin was used to replace the deficient left upper eyelid skin and a scalp composite graft was harvested to replace the deficient left lateral eyebrow. Temporary tarsorrhaphy, and steroid injections were used on multiple occasions to counteract the cicatricial forces. Ultimately, permanent lateral tarsorrhaphy and upper eyelid canthopexy was needed to obtain a satisfactory functional and cosmetic result.

Evaluation of functional and radiological outcome of type iii open distal tibial fractures treated with early internal fixation followed by soft tissue reconstruction [fix and flap]: A prospective study

The treatment of Gustilo Anderson type 3 open distal tibia intrartricular fractures is a major challenge to orthopaedic surgeons which needs aggressive debridement, adequate fixation, and early flap coverage of soft tissue defect through Osteoplastic approach rather than conventional orthopaedic approach alone. The incidence of these fracture are on surge due to urbanistaion and high velocity motor vehicle accidents. This study has been done to evaluate functional and radiological outcome in gustillo type 3b open fractures by early definitve fixation and soft tissue cover. Twenty six patients were operated by fix and flap protocol and evaluated at the end of one year with IOWA ankle scoring system and its radiological outcome and their complications. Among 26 patients treated with this protocol the union rate is 100% and the mean union time is 29weeks with 3 patients developed malunion and one patients presented with ankle arthritis. Two patients (7%) developed deep infection in which one patient also having delayed union and two patients (7%) developed superficial infection. Functional results were graded according to the IOWA ankle scoring system. 11 patients had excellent to good outcomes and 11 were fair outcome and remaining 4 patients shows poor outcome. Fix and Flap in the same sitting using immediate wound cover at the time of definitive fixation, has given good results in our hands despite the communition at fracture site and open wound.

Traumatic Symmetric Biparietal Extradural Hematoma: Report of Two Cases

AbstractTraumatic bilateral epidural hematomas (EDHs) are uncommon and are mostly found in the frontal region because of extension of fracture across the midline and tear of venous sinus. Authors report two cases of mirror image biparietal extradural hematoma after sustaining a high-velocity motor vehicle accident. Both were adult males and had a very low admission GCS of less than 8. Emergency hematoma evacuation was performed bilaterally and good outcomes were achieved in both. Mean follow-up duration was 9 months. The pathophysiologic mechanisms are different from solitary EDH as are the clinical features and outcomes. The rarity of these lesions and surgical nuances are highlighted.

Posterior cruciate ligament tears in Taiwan: an analysis of 140 surgically treated cases

IntroductionPosterior cruciate ligament (PCL) tears are commonly due to motor vehicle accidents or sports-related trauma but can differ geographically. We report the various causes, types, and associated injuries of PCL tears in Taiwan. MethodsOne hundred forty patients with arthroscopically treated PCL tears were reviewed. ResultsScooter-related trauma was the most common cause of PCL tear in our series and is typically an isolated ligamentous injury. High-velocity motor vehicle accidents accounted for a small percentage of PCL tears. ConclusionScooter-related PCL tears are common in Taiwanese patients and are often isolated ligamentous injuries similar to low-velocity sports-related PCL injuries.

English

Introduction:Ipsilateral floating hip and floating knee are very rare injuries. These injuries so uncommon that only three cases of similar kind have been reported. These injuries are due to high velocity injuries following motor vehicle accidents. Management of such complex injuries is a challenging task even in experienced hands as there are no standard treatment guidelines for such fractures.Case Report:We hereby report a 20 yr old male who sustained ipsilateral floating hip and ipsilateral floating knee injuries following motor vehicle accident. Patient was stabilized initially and later taken up for surgery. Patient was treated with interlocking nail for femur and tibia in the same sitting whereas acetabulam fracture was managed conservatively. At five months all the fractures united well with restoration of good range of motion in both hip and kneeConclusion:Ipsilateral floating knee and floating hip are very rare injuries seen following high velocity motor vehicle accidents. There are no standard guidelines for treatment of those fractures as only a few cases of similar kind have been reported in literature. Early fixation and aggressive mobilization ensures fracture union and fewer complications.

Open anterior hip dislocation in a young adult with exposed femoral head and no neurovascular damage.

Anterior hip dislocation is common in younger adults and is the result of severe, high energy trauma such as high-velocity motor vehicle accidents or falls from great heights. A similar mechanism of injury would cause a femur neck fracture in older patients. Of these, open anterior hip dislocations are extremely rare and are usually associated with other soft tissue and bony injuries. We report a case of an open anterior hip dislocation with normal neurovascular status in a third world setting. trauma, open anterior, dislocation, hip, femoral head, osteonecrosis.

Which Comes First in Posterior Shoulder Dislocation; X-Ray or Computed Tomography?

The glenohumeral joint is the most commonly dislocated joint in the human body. Anterior dislocatin is the most common type and posterior dislocations account for <1% of shoulder dislocations. A 28-yearold man was brought to the emergency department by ambulance after a high-velocity motor vehicle accident. At the time of admission he was suffering left shoulder pain. On local physical examination, there was severe pain on the proximal humerus. The left arm was in internal rotation in the adducted position. Radiographs of his left shoulder were performed and no significant pathology was identified in the left shoulder anteroposterior X-ray. Axillary radiography could not be performed because of painful arm movements. Therefore we performed a computed tomography scan, instead of X-ray. The success rate of diagnosing the posterior shoulder dislocations with X-ray is very low. We believe that X-ray, as a primary imaging method, will cause delay in the diagnosis for this group of patients. In the case of suspicion of posterior shoulder dislocations, computed tomography should be the first choice of investigation rather than X-ray.

A 20-Year-Old Male with Back Pain

A 20-year-old, previously healthy, white male, presented with low back and right fl ank pain for 2 weeks. The pain was varying in intensity from moderate to severe and diffuse and radiating to the groin, with no exacerbating or relieving factors and minimal relief with ibuprofen. He said the pain started after he was in a high velocity motor vehicle accident. According to the patient, his car was hit from behind by another vehicle, which resulted in skidding and the patient’s car landing upside down. There was no loss of consciousness. The patient was evaluated by the emergency medical system after the accident and was discharged after a computer-

Femoral Artery Intimal Injury Following Open Reduction of an Acetabular Fracture

Vascular injury is a devastating complication of internal fixation of acetabular fractures. While lacerations of the large vessels may lead to massive bleeding, they are obvious and are addressed immediately during the surgery. We encountered a subtle case of intimal injury and thrombosis of the femoral artery. A 20-year-old man presented with a fractured right acetabulum and right fourth, fifth, and sixth ribs with hemopneumothorax after a high-velocity motor vehicle accident. Twelve days after the injury, open reduction and internal fixation of the acetabular fracture from an ilioinguinal approach was performed. Postsurgically, examination showed no palpable femoral arterial pulse distal to the inguinal ligament. Exploration of the common femoral artery showed arterial thrombus, which was removed by a Fogarty catheter; however, the pulselessness persisted. Further exploration revealed intimal injury of the femoral artery. Replacement of the damaged segment by an interpositional venous graft was performed and peripheral pulses were reestablished. The patient recovered uneventfully. Extreme care should be taken to avoid vascular injury in pelvic fracture surgery. Meticulous surgical technique, particularly in the middle window, is vital to minimizing the risk of this complication. The insidious nature of the intimal arterial injury underlines the necessity of close intraoperative and postoperative monitoring of limb vascularity to detect such vascular lesions immediately and prevent this potentially disastrous complication.

Pancreatic injuries in under‐age Australian rules footballers

Blunt injury to the pancreas is rare in children. It has significant physiological effects and can result in death. The most common injury mechanism is a high-velocity motor vehicle accident. Bicycle accidents, non-accidental injuries and falls can also cause pancreatic injury.(1) Given the protected retroperitoneal location of the pancreas, it is not surprising that low-velocity injuries are an uncommon cause of pancreatic injury. Over a 12-month period we have observed three cases of blunt pancreatic injury, occurring during under-age Australian rules football (AFL) matches. These represented a spectrum of injuries from 'traumatic pancreatitis' to a devascularized distal pancreas requiring initial percutaneous drainage complicated by pseudocyst development requiring cyst gastrostomy. AFL is a free flowing game that combines certain attributes of soccer and rugby. There is an emphasis on physical contact and high-velocity interpersonal collisions are frequent.

Proximal ureteric disruption following blunt abdominal trauma

When present, bluntureteric trauma is often associated with multi-system life-threatening injuries. Because of itsrarity and the urgency to address the associatedlife-threatening injuries, diagnosis of uretericinjuries is often delayed. We present a rare caseof an adult female with lateral abdominal muscu-lature disruption, multiple bowel injuries and anisolated, complete ureteric transection 6 cm distalto the UPJ following a high velocity motor vehicleaccident.

Burn injuries resulting from (accidental) airbag inflation

Introduction: Airbags are intended to minimize facial injuries, alone and when used in combination with seatbelts in high-velocity motor-vehicle accidents. They may occasionally perforate, resulting in the release of sodium azide or sodium hydroxide, which result in chemical burns when in contact with skin. The force of deployment may itself result in significant blunt trauma, and there is a temperature rise during the inflation causing thermal burns, possibly as a separate and unnecessary consequence of a relatively minor accident. Method: A case report is presented. The literature on such injuries was reviewed and the mechanism of airbag deployment commented. Conclusion: Alternative designs and mechanisms of linking the activation of the device to the velocity of travel or to add a switch which is activated when accessing a motorway are recommended.

Removal of a Broken Solid Femoral Nail

An intramedullary nail subjected to cyclical loading will fatigue if stresses on the nail exceed its endurance limit. The factors that influence failure of the nail are the stability of the fracture, a non-union or delayed union, and the rehabilitation program2,3,14,16. The methods to remove the distal fragment of a broken hollow nail rely on the passing of hooks or screws down the center of the nail1,8,10,15. For a solid nail, this technique is not possible. We describe a technique for the removal of the distal segment of a broken solid femoral nail. A twenty-four-year-old man sustained a closed fracture of the left femur, just distal to the isthmus, in a high-velocity motor-vehicle accident. The fracture was classified as B3 according to the AO system11 and as C2 according to the system of Tscherne and Oestern (Fig. 1-A). Other injuries included cerebral contusions, fractures of the right femoral condyle and the right tibial plateau, and dislocations of the right elbow and the right carpometacarpal joint. After initial resuscitation, the left femoral fracture was stabilized with a femoral nail, 420 by nine millimeters, made of titanium alloy (Ti-6Al-7Nb; Synthes, Paoli, Pennsylvania). The nail was inserted without reaming and was locked proximally and distally with two locking screws, each with a core diameter of 4.3 millimeters and an outer diameter of 4.9 millimeters7 (Fig. 1-B). Fig. 1-A: Preoperative radiograph showing the infra-isthmal fracture of the femoral shaft. The screw in the medial femoral condyle had been placed during a previous repair of the posterior cruciate ligament. Fig. 1-B: Radiograph made after insertion of a solid titanium-alloy nail with static locking with screws. The fracture was nailed in slight distraction. At the initial operation, …

Surgical treatment of 35 volar Barton fractures

35 patients with volar Barton fractures were treated operatively from 1985-1994. The injury was due to a high velocity motor vehicle accident in 20 patients. All fractures were closed without major carpal injuries. 11 fractures were type B3.1, 21 type B3.2 and 3 type B3.3. according to the AO classification. All fractures were openly reduced and internally fixated by small buttress plates and screws. In 31 cases, the median nerve was unaffected by the injury and was not explored or decompressed during surgery. The patients were assessed clinically and radiographically after mean 6 (2-10) years. According to the criteria of Pattee and Thompson (1988), 23 patients had excellent results, 10 good and 2 fair. Posttraumatic arthrosis was found in 12 patients and was related to the congruency of the articular surface achieved at surgery. We conclude that the median nerve, when not damaged or compressed, should not be explored or decompressed during surgery.

Acrylic splints for dental alignment in complex facial injuries.

Twenty-four patients with complex facial injuries were managed by wide subperiosteal exposure, precise anatomical reduction, rigid internal fixation, and immediate bone grafting when indicated, in conjunction with dental impressions, model surgery, and fabrication of dental splints to establish proper preinjury occlusion. The study population consisted of 18 men and 6 women, whose ages ranged from 18 to 49 years (mean, 30.7 yr) at the time of injury. High velocity motor vehicle accidents were responsible for facial injuries in 18 patients, gunshot wounds in 2, low velocity blunt trauma in 3, and falls in 1. All facial fractures involved the occlusion, and unstable and/or comminuted palatal/maxillary and mandibular fractures, often with edentulous segments, were the major indications for fabrication of acrylic splints. Depending on the nature of the fracture pattern, model surgery was performed on the maxillary and/or mandibular models and segmented along fracture lines. These fragments were then repositioned according to dental wear facets and preinjury occlusion. When possible, preinjury occlusal records were obtained before splint fabrication. Models were mounted on a Galetti articulator and palatal, lingual, and/or occlusal splints were fabricated. Edentulous segments were compensated for by local buildup of the splints to produce an occlusal stop. Arch bars were fixed directly to the splint with acrylic. Twenty-six splints were used in the 24 patients to establish proper occlusal relationships before internal fixation of fractures. The types of splints were palatal (n = 8), palatal-occlusal (n = 6), lingual (n = 8), lingual-occlusal (n = 1), and occlusal (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Naso-orbital-ethmoid injury: Report of a case and review of the literature

Trauma to the midface severe enough to cause nasal fractures will often result in fractures of the bony naso-orbital-ethmoid (NOE) complex. Extensive damage may be encountered in the interorbital area because of the fragility of the bony framework. The medial orbital walls, ethmoid sinuses, and cribriform area of the anterior cranial fossa can resist a maximum compressive force of only 30 g. NOE injuries are usually the result of either a direct blow sustained during an altercation or of a high-velocity motor vehicle accident. Quite often multiple systemic injuries serve to complicate treatment. NOE fractures present the surgeon with numerous challenges during repair. The delicate bony architecture, anatomic framework, and cosmetic expectations indicate comprehensive, thorough treatment. Damage to the eye, which is basically an extension of the brain, is of major concern. Pupillary discrepancies, retrobulbar hematoma, and damage to the optic nerve must be ruled out. Early surgical management is indicated because delayed repair or inadequate treatment prediposes the patient to defects that may be extremely difficult if not impossible to correct with secondary procedures. Numerous articles have been published describing the NOE injury. The multifaceted array of fractures seen in NOE injuries has been formulated into a comprehensive classification by Gruss.

Head-in-motion contusions in young adults.

The pathogenesis of contusions was studied in a series of acute fatal closed head injuries. Important factors include: 1. whether the head was in motion or stationary; 2. the direction and magnitude of the force; 3. the presence of depressed fractures and lacerations; and 4. roughness of the overlying bone. In the young adult group, the frequent high velocity motor vehicle accidents create a dominant pattern of injury to the frontal and temporal lobes, usually sparing the occipital lobes and cerebellum.

Fractures Involving the Distal Epiphyseal plate of the femur.

Forty-two fractures involving the distal femoral epiphyseal plate in 41 patients were reviewed. The average age at injury was 11.2 years. The follow up period ranged from one year to 20.3 years, with an average of 6.3 years. The Salter-Harris classification of epiphyseal plate injures proved to be a good indicator of the mechanism of injury and prognosis. Using stringent criteria to classify the end results, 2 out of 3 of the total group and 3 out of 4 of 29 Salter-Harris Type I and Type II injuries had good or excellent results. Type V crushing injuries of the growth plate, open injuries, fractures caused by high velocity motor vehicle accidents with severe displacement or multiple associated fractures, and incompletely reduced epiphyseal injuries gave only poor or fair results. Major problems responsible for poor or fair results were varus or valgus angulation, loss of joint motion and shortening due to premature epiphyseal closure. Orthoradiographs revealed the presence of some degree of shortening in 20 of 29 Salter-Harris Type I and Type II injuries which averaged 1.0 cm, but was of no clinical significance in most patients. These injuries must be reduced accurately. In the Type II epiphyseal separations unsatisfactory results were due to inadequate reduction or to associated injuries.