Injury Classification Research Articles

Frequency of Chronic Pain after Work-Related Trauma: A Preliminary Status Survey during Workers' Compensation Rehabilitation in a Tertiary Clinic

Chronic pain after trauma and surgery is a long-term complication. Its relevance for patients within the workers' compensation rehabilitation process has not been adequately investigated. Initial evaluation of frequency of chronic pain after occupational accidents. In 2017, surgical inpatients (18-65 y) treated in a tertiary hospital were asked about chronic pain arising from an occupational trauma recognized by statutory occupation insurance (interval 2.8±6.9 years), regardless of care received, first at the time of hospitalization and then by telephone interview 6 months later. The focus was on patients with a work-related trauma (A) within the past month or (B) >6 months. frequency of work trauma-related chronic pain (>6 months) at the initial interview (point prevalence), secondary outcomes: frequency of chronicity at 6 months (A) and persistence of chronic pain (B). Tertiary outcomes: ability to work, occupational injury classification, burden based on pain intensity, localization, and medication, functional deficits due to the existence of chronic pain, and comorbidity. Out of 415 patients included in the survey, 85% (160/188) reported accident-related chronic pain (predominantly moderate to highly severe in intensity, localized at joints and bones). 90% (131/145) also reported this pain six months later. 67% (64/96) reported chronic pain for the first time. Patients with chronic pain at follow-up (281/369) were less likely to return to work (p=0.003), required analgesics in 60%, were more often comorbid (p<0.002) and had greater functional deficits (p<0.002). Despite the preliminary nature of the data, chronic pain seems to be common after occupational trauma and negatively affects the recovery of work ability in the long term. Based on the present observational data, a further differentiated re-evaluation of prospective data considering therapeutic measures is strongly recommended.

Weightbearing Computed Tomography vs Conventional Tomography for Examination of Varying Degrees of Lisfranc Injures: A Systematic Review of the Literature.

Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic resonance imaging (MRI), and conventional computed tomography (CT) scan to differentiate Lisfranc instability, but they focused on a healthy/injured scale without differentiating subtle injury. Weightbearing CT (WBCT) has emerged as a diagnostic tool for detecting subtle Lisfranc injuries. This systematic review aimed to compare WBCT with conventional CT in diagnosing Lisfranc injury, and the ability to differentiate injuries of varying severities. The review encompassed PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases from inception until July 5, 2023. Inclusion criteria involved studies on CT and/or WBCT for Lisfranc injuries and nonoperative studies. Exclusion criteria composed case reports, commentaries, postoperative imaging studies, pediatric patients, studies with nonobjective radiographic measurements, studies exclusively focused on injury classification, and studies with fewer than 5 patients because of poor statistical power. Data extraction focused on radiographic measurements of the Lisfranc complex, categorized into conventional CT, partial WBCT, and total WBCT. Out of the initially retrieved 489 articles, 9 met the inclusion criteria. Several studies consistently demonstrate that WBCT provides a higher level of accuracy in measuring the Lisfranc area, offering enhanced sensitivity to detect subtle alterations in joint structure. Moreover, WBCT exhibits superior sensitivity in distinguishing between healthy Lisfranc joints and those with injuries, particularly when identifying dorsal ligament damage. This imaging modality allows for the detection of significant variations in critical measurements like first-second metatarsal (M1-M2) distance, first cuneiform (C1)-M2 distance, and joint volumes, enabling a more comprehensive assessment of Lisfranc joint health especially with subtle instability. This review evaluates the extant literature on WBCT's utility in diagnosing Lisfranc injuries and compares its effectiveness to CT in distinguishing between injuries of varying severity. WBCT, with reliable measurement techniques, appears more adept at detecting subtle Lisfranc instability compared to CT, likely by allowing the assessment of injury under load.

Do Syndesmotic Injury Patterns Influence Functional and Radiological Outcomes in Complex Ankle Fractures? A Retrospective Cohort Study

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis injury can be of a varying magnitude; little information exists about the influence of degree of initial syndesmotic injury/instability on functional outcomes in ankle fractures, nor is there any correlation of this with follow up radiological parameters. Aims and Objectives: To identify and define morphological patterns of syndesmotic injury in ankle fractures according to a zone based evaluation, and correlate initial degree of instability with mid-term functional and radiological outcomes using validated scores Design: Retrospective cohort study, to review a prospective question. Methods: 40 complex ankle fractures out of 120 ankle fractures in our ankle registry met the inclusion criteria ie significant documented syndesmosis involvement needing stabilization, with all initial clinical and radiological records available. The patients were followed up between January 2020 to July 2021. Injury characteristics, fracture morphology of posterior malleolus, medial malleolus and fibula were noted and classified by validated classification systems based on x-rays and CT scan. The syndesmosis was analyzed on axial CT scan; it was divided into 3 zones, A,B,C from anterior to posterior, and degree of displacement and morphology was noted. Immediate post-operative radiographs were evaluated for fracture and syndesmosis reduction. The patients were evaluated at final follow up with both ankle specific scores (Olerud Molander score, Ankle-Hindfoot scale, Manchester-Oxford Foot questionnaire) and quality of life score (SF-12). Ankle Osteoarthritis grade was used to evaluate radiological outcomes. Results: Mean follow-up was 19 months. 22(55%) patients had syndesmotic widening on plain radiographs; however in pre- operative CT scan evaluation 40(100%) patients had syndesmotic injury based on the Zone evaluation of the syndesmosis. 22 patients had Zone A injury (widening, AITFL, Chaput, Wagstaff). 22 patients had widening of Zone B. Zone C was involved in 30 patients (PM fracture,PITFL involvement). At final follow up; the mean OMAS was 83.38±16.35, mean Ankle-Hindfoot scale= 88±9.98, mean Mox-FQ score=27.15±13.35 &amp; mean SF-12 were (MCS=56.59±8.24, PCS=51.18±8.48). There was no significant difference in outcome scores based on fracture types, Posterior malleolus morphology, or based on zones of syndesmosis injury. Syndesmosis malreduction contributed to significantly poorer outcomes (SF-12, OMAS, MoxFQ) Conclusion: Despite a zonal classification of syndesmotic injury on CT and more clarity of injury patterns, we could not corelate the site and extent of syndesmotic injury with final functional and radiological outcomes. The one factor that has significant influence is initial accurate reduction of both the malleolar fractures and syndesmosis injury. In this the CT based axial classification may play a role.

Evaluation of the intra- and inter-reliability of injury classification in Australian rugby union using video analysis

Evaluation of the intra- and inter-reliability of injury classification in Australian rugby union using video analysis

Vascularized Toe Proximal Interphalangeal Joint Transfer in Posttraumatic Fingers: Analysis of Prognostic Factors for Suboptimal Outcomes.

Posttraumatic finger osteoarthritis of the proximal interphalangeal joint (PIPJ) is a difficult problem. Over the past decade, we have reported several methods for improving the outcomes of vascularized toe joint transfer (VJT). In this study, we focused on determining poor prognostic factors which lead to a suboptimal outcome. A consecutive series of patients with posttraumatic osteoarthritis of the PIPJ who received VJT between January 2008 and January 2021 were enrolled in this study. The senior surgeon (Y.-T.L.) performed the surgery in all cases. In this retrospective study, we reexamine the initial trauma-related soft tissue and bony structure injuries of the recipient finger, to assess the baseline tissue quality before VJT. The injuries were classified into five major categories according to their anatomic region. The functional outcome parameters (including range of motion, percentage of use, and extensor lag of the transferred PIPJ) were collected. Univariate and multivariate linear regression analyses were performed using the generalized estimated equation model to identify the correlation between the injury category involved and functional outcome. A total of 59 digits were enrolled. Our results revealed that the fingers with previous vascular injury that received revascularization procedures had relatively suboptimal functional outcomes. These fingers had a significantly lower percentage of use both before (β = -0.222, P = 0.006) and after (β = -0.177, P = 0.006) receiving secondary procedures to improve functional outcome. Patients with prior revascularization surgery were associated with a poor functional outcome after VJT.

Age and anatomical-functional nuances of traumatic brain injury in children

The purpose. Traumatic brain injury in children is a serious medical problem that requires special attention and research. As the child's body develops and grows, the anatomical and functional characteristics of children can affect the pathological consequences of traumatic brain injury. Given the growing number of children who are injured in sports events, accidents and other factors, understanding the characteristics of this category of injury can play an important role in improving their treatment and rehabilitation. Children respond to injury differently than adults and may exhibit different symptoms and require specialized medical care and approaches to treatment and rehabilitation. Understanding these age and anatomical and functional differences can help improve the diagnosis and treatment of brain injury in children and increase their chances of full recovery and normal development. Materials and methods. 154 charts of inpatients aged from 1 month to 17 years who were receiving inpatient treatment at the regional children's hospital during 2022 were analyzed. The basic methods of examination were radiographs, MRI of the brain.Research results. The most craniocerebral traumas were observed in children aged 7-17 years, which constituted 47.4%. Children aged 3-6 were often injured, accounting for almost 20%, older children (15-17 years old) were injured less often, accounting for 15%. Babies under one year old (9.7%) and children under 2 years old (8.4%) suffered the least amount of damage. The largest number of injured children (60.4%) was observed in the warm season when they are active outside without proper parental supervision.Conclusions. The largest number of brain injuries is characteristic of adolescence, against the background of changes in all body systems, the formation of new behavioral reactions for them, which were not characteristic of them before, and contribute to the increase in traumatism. Babies suffered the least damage, which is due to the anatomical features of the structure of the child's head.

Validation of a New Tool to Detect and Characterize Spinal Cord Injury in the Acute Trauma Patient: The Montreal Acute Classification of Spinal Cord Injury.

Retrospective validation protocol. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most comprehensive tool for classifying spinal cord injuries (SCI), but it is not adapted for the evaluation of trauma patients. The objective is to develop and validate a streamlined tool, the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI) that can be integrated in the evaluation of trauma patients to detect and characterize traumatic SCI (tSCI). The completion rate of the ISCNSCI during initial evaluation after tSCI was estimated at a Level-1 trauma center specialized in SCI care. Using a modified Delphi technique, we designed the MAC-SCI, a new tool to detect and characterize the severity grade and level of SCI in the polytrauma patient. A cohort consisting of 35 consecutive tSCI patients with complete ISNCSCI documentation was used to validate the MAC-SCI. The severity grade and neurological level of injury (NLI) were assessed using the MAC-SCI, and compared to those obtained with the ISNCSCI. Only 33% of 148 patients admitted after a tSCI had a complete ISNCSCI performed at initial presentation. The MAC-SCI retains 53 of the 134 elements from the ISNCSCI. There was a 100% concordance in severity grade between the MAC-SCI and ISNCSCI. The NLI were within 2 levels between the MAC-SCI and ISNCSI for 100% of patients. The MAC-SCI is a streamlined tool that accurately detects and characterizes tSCI in the acute trauma setting. It could be implemented in trauma protocols to guide the management of SCI patients. Level III Diagnostic criteria.

Ağaçtan Düşmelerin Torakolomber Yaralanma Sınıflandırma Sistemi Skorları ve Hasta Sonuçları Açısından Analizi

Aim: Falling from trees are main problems of occupational healthcare. Patients falling from trees are suffered from spinal and extremity injuries due to high energy traumas. Our aim with this study was to reveal the differences in thoracolumbar injury classification system (TLICS) scores, degrees of spinal damage and treatments of traumas belonging to patients who presented with falls from different tree species in different plantations.&#x0D; Material and Methods: This is a retrospective observational study. Patients who were brought to the emergency department due to falling from a tree between 2015-2020 were included. Characteristics of injuries due to falls from trees, TLICS scores, treatment types and 3 month follow up results were obtained from the hospital information system and comparative analysis was done.&#x0D; Results: The mean age of the patients was 53.25±17.9 years and 54.9% were male. 33(64.7%) patients had undergone vertebroplasty or stabilization. According to height categories, TLICS scores(p=0.003) and stabilization levels(p=0.003) were statistically higher in taller tree categories (p=0.003). Although surgical interventions were statistically higher in tree falls higher than four meters (p=0.026), there was no statistically significant difference between trees in terms of treatment type (p=0.315), VAS score (p=0.219) and 30-day VAS score (p=. 0.329) In addition, the change in Visual Analogue Scale (VAS) score was statistically higher in operated patients (median VAS=7) than in non-operated patients (median VAS=5.5) (p=0.012).&#x0D; Conclusion: Our findings reveal that TLICS scores are significantly associated with tree heights and operate with good results in VAS scores.

Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Behavioral Phenotyping.

The recent publication of practice guidelines for management of patients with disorders of consciousness (DoC) in the United States and Europe was a major step forward in improving the accuracy and consistency of terminology, diagnostic criteria, and prognostication in this population. There remains a pressing need for a more precise brain injury classification system that combines clinical semiology with neuroimaging, electrophysiologic, and other biomarker data. To address this need, the National Institute of Neurological Disorders and Stroke launched the Common Data Elements (CDEs) initiative to facilitate systematic collection of high-quality research data in studies involving patients with neurological disease. The Neurocritical Care Society's Curing Coma Campaign expanded this effort in 2018 to develop CDEs for DoC. Herein, we present CDE recommendations for behavioral phenotyping of patients with DoC. The Behavioral Phenotyping Workgroup used a preestablished, five-step process to identify and select candidate CDEs that included review of existing National Institute of Neurological Disorders and Stroke CDEs, nomination and systematic vetting of new CDEs, CDE classification, iterative review, and approval of panel recommendations and development of corresponding case review forms. We identified a slate of existing and newly proposed basic, supplemental, and exploratory CDEs that can be used for behavioral phenotyping of adult and pediatric patients with DoC. The proposed behavioral phenotyping CDEs will assist with international harmonization of DoC studies and allow for more precise characterization of study cohorts, favorably impacting observational studies and clinical trials aimed at improving outcome in this population.

Research status of dural injury types and repair

To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.

Acute assessment of spinal cord injury in New South Wales: A retrospective study of current practice in two spinal cord injury referral centers

Introduction Interventions provided in the early phases after spinal cord injury (SCI) may improve neurological recovery and provide for best possible functional outcomes. Knowing this relies on early and clear documentation of the level and grade of the spinal cord injury. Guidelines advocate for early documentation of neurological status within 72 h of injury to allow early prognostication and to help guide initial management. It is unclear whether this is current practice in New South Wales (NSW). Methods Patients with acute SCI who were admitted to two SCI referral centers during 2018–2019 in NSW were included. Data relating to documentation of neurological status, timing of imaging, surgery and transfer to spinal cord injury center were collected and summarized using descriptive statistics. Results Only 18 percent of patients had an acceptable neurological examination according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) within 72 h of injury (either not done, or unable to determine the neurological level of injury). At the first neurological examination, the neurological level of injury and grade was unable to be determined in 26.8% of patients and 29.9% of patients respectively. At discharge from acute care and transfer to rehabilitation, the neurological level was undetermined in 28.9% of patients and grade undetermined in 26.8%. ISNCSCI examination was most commonly performed by spinal rehabilitation doctors after patients were discharged from the intensive care unit (ICU). Conclusions Documentation of neurological level and grade of SCI within 72 h of injury is not being performed in the large majority of this cohort, which may impede evaluation of neurological improvement in response to acute treatment, and hinder prognostication.

Musculoskeletal injuries profile of patients applying to a sports medicine outpatient clinic

Background/Aim: Sports injuries represent a significant public health concern, and their prevalence is on the rise due to the growing global population and increased participation in amateur and professional sports. Epidemiological studies on sports injuries are crucial in identifying priority areas for injury prevention efforts. While there is a wealth of research on musculoskeletal injuries specific to various sports, there is a scarcity of epidemiological studies focusing on patients seeking care at sports medicine outpatient clinics. This study aims to define and categorize the diagnoses of patients presenting to a sports medicine outpatient clinic for musculoskeletal injuries. Methods: This retrospective cohort study included all patient visits for musculoskeletal injuries at the sports medicine outpatient clinic between 1 July 2022 and 30 June 2023. Patients with complaints other than musculoskeletal injuries and those lacking sufficient data (diagnosis or injury type) in the data recording system were excluded. Data recorded for each participant included age, sex, symptoms, injured body region, and injury type. Diagnoses were categorized using the Orchard Sports Injury and Illness Classification System (OSIICS) v.13. Descriptive analyses provided a detailed overview of reported injuries, including counts and proportions within specific injury categories. Categorical variables are presented as ‘n’ and (%), while continuous variables are expressed as medians with interquartile ranges (IQRs). Results: Data from 1,203 patients (395 females and 808 males) were analyzed, with a mean age of 24 (2.2) years. A total of 1393 injuries were documented, with the knee being the most commonly injured body region (n=398, 30.7%). Among the OSIICS v.13 injury categories, muscle/tendon injuries constituted 33.7% (n=466) of all injuries, followed by cartilage/synovium/bursa injuries (n=432, 31.2%). Conclusion: This study revealed that the knee was the most frequently injured body region among patients seeking care at the sports medicine clinic for musculoskeletal injuries. Muscle/tendon injuries were the predominant type of injury observed.

PREVALENCE AND IMPACT OF DENTOALVEOLAR TRAUMA IN CHILDREN AND ADOLESCENTS

The study addresses the prevalence and impact of dentoalveolar traumas in children and adolescents. These traumas rank second among the most common accidents in this age group and are gaining increasing global attention due to associated physical and psychological implications. Detailed clinical assessment, along with radiographic examinations, is crucial for accurate diagnosis and the selection of appropriate treatment. Dental traumas often affect the supporting dental tissues, with varying degrees of severity, ranging from subtle cracks in the dental enamel to more severe injuries such as luxations and avulsions, which can also involve damage to surrounding bone structures. These traumas are one of the main causes of tooth loss in children, especially the upper anterior teeth, with a wide variation in incidence. Causes range from accidental falls to sports activities and other events. For rapid and accurate diagnosis, it is important to conduct a methodical assessment of patients, considering incident details and possible associated symptoms. Proper treatment performed by dental surgeons is crucial to prevent irreversible damage. The study also discusses the classification of traumatic dental injuries, encompassing different types of fractures and displacements, both in dental tissues and supporting structures. Pulp necrosis is one of the main consequences of these traumas, which can have aesthetic, psychological, and social impacts, in addition to implying significant costs. Immediate care is important, but long-term follow-up is often necessary. In summary, the study emphasizes the importance of dentoalveolar traumas in children and adolescents, highlighting their prevalence, classification, and implications. It also underscores the need for proper diagnosis and treatment, as well as the importance of long-term follow-up to minimize the adverse effects of these injuries.

Improved chest wall trauma taxonomy: an interdisciplinary CWIS and ASER collaboration.

Chest wall injury taxonomy and nomenclature are important components of chest wall injury classification and can be helpful in communicating between providers for treatment planning. Despite the common nature of these injuries, there remains a lack of consensus regarding injury description. The Chest Wall Injury Society (CWIS) developed a taxonomy among surgeons in the field; however, it lacked consensus and clarity in critical areas and collaboration with multidisciplinary partners. We believe an interdisciplinary collaboration between CWIS and American Society of Emergency Radiology (ASER) will improve existing chest wall injury nomenclature and help further research on this topic. A collaboration between CWIS and ASER gathered feedback on the consensus recommendations. The workgroup held a series of meetings reviewing each consensus statement, refining the terminology, and contributing additional clarifications from a multidisciplinary lens. After identifying incomplete definitions in the CWIS survey, the workgroup expanded on and clarified the language proposed by the survey. More precise definitions related to rib and costal cartilage fracture quality and location were developed. Proposed changes include more accurate characterization of rib fracture displacement and consistent description of costal cartilage fractures. The 2019 consensus survey from CWIS provides a framework to discuss chest wall injuries, but several concepts remained unclear. Creating a universally accepted taxonomy and nomenclature, utilizing the CWIS survey and this article as a scaffolding, may help providers communicate the severity of chest wall injury accurately, allow for better operative planning, and provide a common language for researchers in the future.

Concordance between needle electromyography and manual muscle test findings for muscles with motor grades 0 and 1.

When it is difficult to determine whether a muscle is grade 0 or 1, manual muscle test (MMT) accuracy can be further improved by using needle electromyography (EMG) as a supplementary and confirmatory examination tool. To evaluate concordance between needle EMG and MMT findings for key muscles with motor grades 0 and 1 on the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, and to potentially improve the prognosis for grade 0 muscles with proven muscle activity based on needle EMG findings. A retrospective analysis. Inpatient tertiary rehabilitation facility. Not applicable. One hundred seven patients with spinal cord injury (SCI) admitted for rehabilitation (n = 1218 key muscles, grades 0 or 1). Inter-rater reliability between MMTs and needle EMG was analyzed using Cohen's kappa coefficient (κ). A Mantel Haenszel linear-by-linear association chi-square testwas used to determine whether the presence of motor unit action potentials (MUAPs) in muscles graded 0 on the initial MMT at admission was associated with MMT grades at discharge and readmission. Moderate-to-substantial agreement between needle EMG and MMT findings was observed (κ = 0.671, p < .01). Concerning key upper and lower extremity muscles, moderate and substantial agreement was identified, respectively. The lowest agreement was noted for C6 muscles. During follow up, 68.8% of muscles with proven MUAPs showed improved motor grades. At initial assessment, distinguishing between motor grades 0 and 1 is imperative because motor grade 1 muscles are more likely to have a better prognosis for improvement. Moderate-to-substantial agreement was observed between MMT and needle EMG findings. The MMT is a reliable method of muscle grading, yet needle EMG may be of value in certain clinical situations to evaluate for the presence of MUAPs when evaluating motor function.

Is an Exercise-Based Injury-Prevention Program Effective in Team Handball Players? A Systematic Review and Meta-Analysis.

To assess the effectiveness of exercise-based injury-prevention programs in preventing sports injuries in team handball players. Scopus, PubMed, Web of Science, SPORTDiscus, and CINAHL from inception until April 2023. Studies were included if they were randomized controlled trials or prospective cohort studies, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injuries, and reported injury incidence rates specific to team handball players. Two researchers independently evaluated studies for inclusion and assessed their methodological quality. Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by 2 independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: shoulder injuries, lower extremity injuries, knee injuries, anterior cruciate ligament injuries, and ankle injuries. Extracted data were analyzed using a random-effects model to compute the overall effect estimates of injury-prevention programs in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group. Meta-analyses were conducted independently for each injury classification. Results indicated that prevention programs reduced the risk of shoulder injuries (OR = 0.60; 95% CI = 0.42, 0.85; P = .004), lower extremity injuries (OR = 0.59; 95% CI = 0.37, 0.95; P = .03), knee injuries (OR = 0.53; 95% CI = 0.35, 0.78; P = .002), anterior cruciate ligament injuries (OR = 0.66; 95% CI = 0.45, 0.96; P = .03), and ankle injuries (OR = 0.57; 95% CI = 0.40, 0.81; P = .002) in team handball players. In team handball players, injury-prevention programs appear to effectively reduce the risk of shoulder, lower extremity, knee, ankle, and anterior cruciate ligament injuries.

Injury severity prediction of cyclist crashes using random forests and random parameters logit models

Cycling provides numerous benefits to individuals and to society but the burden of road traffic injuries and fatalities is disproportionately sustained by cyclists. Without awareness of the contributory factors of cyclist death and injury, the capability to implement context-specific and appropriate measures is severely limited. In this paper, we investigated the effects of the characteristics related to the road, the environment, the vehicle involved, the driver, and the cyclist on severity of crashes involving cyclists analysing 72,363 crashes that occurred in Great Britain in the period 2016–2018. Both a machine learning method, as the Random Forest (RF), and an econometric model, as the Random Parameters Logit Model (RPLM), were implemented.Three different RF algorithms were performed, namely the traditional RF, the Weighted Subspace RF, and the Random Survival Forest. The latter demonstrated superior predictive performances both in terms of F-measure and G-mean. The main result of the Random Survival Forest is the variable importance that provides a ranked list of the predictors associated with the fatal and severe cyclist crashes. For fatal classification, 19 variables showed a normalized importance higher than 5% with the second involved vehicle manoeuvring and the gender of the driver of the second vehicle having the greatest predictive ability. For serious injury classification, 13 variables showed a normalized importance higher than 5% with the bike leaving the carriageway having the greatest normalized importance. Furthermore, each path from the root node to the leaf nodes has been retraced the way back generating 361 if-then rules with fatal crash as consequent and 349 if-then rules with serious injury crash as consequent. The RPLM showed significant unobserved heterogeneity in the data finding four normal distributed indicator variables with random parameters: cyclist age ≥ 75 (fatal prediction), cyclist gender male (fatal and serious prediction), and driver aged 55–64 (serious prediction). The model’s McFadden Pseudo R2 is equal to 0.21, indicating a very good fit. Furthermore, to understand the magnitude of the effects and the contribution of each variable to injury severity probabilities the pseudo-elasticity was assessed, gaining valuable insights into the relative importance and influence of the variables.The RF and the RPLM resulted complementary in identifying several roadways, environmental, vehicle, driver, and cyclist-related factors associated with higher crash severity. Based on the identified contributory factors, safety countermeasures useful to develop strategies for making bike a safer and more friendly form of transport were recommended.

The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint

BackgroundAcute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury.MethodsFrom May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described.ResultsEither an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)).ConclusionsHigh frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

The RIGHT Scoring System for the Medicolegal Classification of Head Injury.

In India, in case of an allegation of assault, the medical officer is required to classify the nature of injury into simple, grievous, and dangerous based upon the Indian Penal Code, which is outdated and has numerous gray areas. The aim of this study is twofold: first, to formulate an objective scoring system for the medicolegal classification of head injuries and Second to validate the proposed scoring system on patients with head injury. A panel of experts consisting of neurosurgeons, radiologists, and forensic specialists came up with an objective scoring system, coined as the RIGHT (radiological-intervention-Glasgow Coma Scale (GCS)-based head trauma) scoring system consisting of three parameters, namely, the motor subscore of the GCS, computerized tomography image findings, and management of the patient. This was used to classify head injuries-into simple, grievous, and dangerous. A single-centre pilot study was planned-including patients with head trauma reporting to the emergency department. Medicolegal nature of the head injury was classified according to the proposed RIGHT score. A 6-month follow-up was performed using the Glasgow Outcome Score (GOS). In total, 130 patients with head injury reported to the emergency department. There was a significant correlation between the RIGHT score assigned upon admission and the GOS at 6 months (P < 0.001). As the scoring system could be applied objectively and a significant correlation between nature of injury given by RIGHT score and 6-month outcome was present; therefore, the RIGHT scoring system proved to be an effective method in unambiguously classifying the nature of head injury for medicolegal opinions.

Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O-Arm Navigation for Single-Stage Management of Severe Lower Cervical Fracture Dislocation.

The incidence of severe lower cervical fractures and dislocations due to trauma has increased significantly, and the optimal treatment remains controversial. This study compares the safety and efficacy of anterior cervical discectomy fusion (ACDF) combined with lateral mass screw (LMS) and with cervical pedicle screw (CPS) fixation surgery under O-arm navigation as single-stage treatments of severe lower cervical fracture dislocations. Data from 48 patients who underwent ACDF + CPS (Group A) or ACDF + LMS (Group B) for severe lower cervical fracture dislocation between January 2016 and September 2020 were retrospectively reviewed. Groups A and B comprised 25 and 23 cases, respectively. Clinical parameters, such as operative time, intraoperative blood loss, number of fixed segments, posterior incision length, operative complications, and hospitalization days were recorded. Preoperatively and postoperatively, the sub-axial injury classification (SLIC) score, the American Spinal Injury Association (ASIA) impairment scale, and the Japanese Orthopaedic Association (JOA) score were recorded and analyzed using Student's t-test. The SLIC scores were 7.1 ± 1.2 and 7.5 ± 1.1, ASIA were 1.5 ± 0.6 and 1.2 ± 0.6, JOA score improvements were 3.2 ± 2.4 and 3.0 ± 2.1, operative times were 282.1 ± 91.7 and 266.5 ± 88.2 min, intraoperative blood losses were 437.8 ± 118.5 and 418.7 ± 104.2 mL, fixed segments were 2.8 ± 0.7 and 4.8 ± 1.1, and lengths of posterior incisions were 12.7 ± 2.8 and 13.8 ± 3.2 cm in Groups A and B, respectively. There was no significant difference between the two groups in the operative time, intraoperative blood loss, incision length, and postoperative recovery; however, group A had more fixed segments. At the final follow-up, no intraoperative or postoperative complications directly caused by the implant were present. Throughout the follow-up, all cases showed recovery and progressive improvement. Both ACDF + LMS and ACDF + CPS under O-arm navigation can safely and effectively restore cervical vertebral sequence, fully release spinal canal compression, and promote patients' neurological recovery. Thus, both are effective treatments for severe lower cervical fracture dislocations. However, compared to LMS, CPS under O-arm navigation has shorter fixed segments and induces less trauma.