Traffic Accident Injury Research Articles

Effectiveness analysis of distal radius microplate locking plate for treatment of displaced fracture of medial clavicle

To investigate and evaluate the effectiveness of the distal radius microplate locking plate for the treatment of displaced fracture of medial clavicle. Between January 2013 and June 2017, 18 cases of obvious displaced fracture of medial clavicle were treated with distal radius microlocking plate. There were 10 males and 8 females, with an average age of 51.4 years (range, 18-88 years). Causes of injury included traffic accident injury in 15 cases, heavy object injury in 3 cases; all of them were closed injury. According to Edinburgh classification, 15 cases were ⅠB1 type and 3 cases were ⅠB2 type. Fracture displacement was 12-21 mm (mean, 16.3 mm). The time from injury to operation was 3-7 days (mean, 4.3 days). After operation, the clinical healing and complications of fracture were observed, and shoulder function was evaluated according to Rockwood's scoring criteria. No incisional infection, neurovascular injury, or other early complications occurred. All 18 patients were followed up 8-15 months (mean, 12 months). All fractures reached clinical osseous union, and the healing time was 8-24 weeks (mean, 16.6 weeks). Postoperative plate loosening occurred in 1 case, which was removed surgically, while other patients did not suffer from complications such as bone nonunion, displacement, internal fixator loosening, and loss of reduction. At last follow-up, according to Rockwood's scoring criteria, the results were excellent in 12 cases and good in 6 cases. The distal radius microplate locking plate is effective for the treatment of displaced medial clavicle fracture, which has few complications, and is feasible for early functional exercise, and is helpful for the recovery of shoulder joint function.

Repair of limb wounds with free profunda artery perforator flap in posteromedial femoral region

To explore the effectiveness of free profounda artery perforator flap (PAPF) in the posteromedial femoral region for the treatment of traumatic skin defects of limbs. Between March 2015 and April 2017, 11 cases of traumatic limb skin defect with deep tissue exposure were treated with free PAPF in posteromedial femoral region. There were 7 males and 4 females, with an average age of 39 years (range, 26-54 years). There were 4 cases of upper limb skin defect and 7 cases of lower limb skin defect. The causes of injury included 6 cases of traffic accident injury, 3 cases of machine crush injury, and 2 cases of crush injury. The size of wounds ranged from 11 cm×7 cm to 18 cm×11 cm. The time from post-traumatic admission to flap repair were 4-9 days (mean, 7.3 days). The size of free PAPF ranged from 15 cm×9 cm to 22 cm×13 cm. The donor site of 8 cases were closed directly; 3 cases could not be closed directly, and skin grafting was used to cover the wound. The time of skin flap harvest was 40-90 minutes (mean, 47 minutes). All flaps and skin grafts survived and the wounds healed by first intention. All the 11 patients were followed up 6-19 months (mean, 12 months). The skin flaps were soft in texture, similar in color to the skin around the injured limbs, without obvious pigmentation and hair overgrowth. Three of them underwent second-stage skin flap thinning. At last follow-up, the limb function of all patients recovered well. Longitudinal scar could be seen in the donor site of the flap, and the location was concealed. All patients did not complain that scar of the donor site affected their sexual life during the follow-up. Free PAPF can achieve satisfactory results in repairing skin defects of extremities. The flaps have the advantages including constant perforator branches, simple operation, and concealed donor site.

Effectiveness of patellar tendon reconstruction with LARS artificial ligament for old patellar tendon rupture

To explore the effectiveness of patellar tendon reconstruction by using LARS artificial ligament in treatment of old patellar tendon rupture. A clinical data of 12 patients with old patellar ligament ruptures, who met the inclusive criteria and reconstructed with LARS artificial ligament between December 2011 and December 2017, was retrospectively analyzed. There were 8 males and 4 females with an average age of 33.5 years (range, 18-55 years). The cause of injury included traffic accident injury in 4 cases, sport injury in 5 cases, and violent injury in 3 cases. There were 5 cases in the left knee and 7 cases in the right knee. The disease duration was 2-12 weeks (mean, 2.5 weeks). The preoperative Lysholm score and Kujala score were 43.2±3.2 and 43.9±2.6, respectively. The knee range of motion was (106.5±14.7)°. The thigh circumference which was measured at 10 cm above the upper end of the patella was (40.92±1.93) cm. There were 4 cases of patellar ligament body rupture, 1 case of patella distal pola rupture, and 7 cases of tibial tuberosity attachment rupture. Preoperative Caton-Deschamps index was 1.47±0.13. All patients were followed up 12-30 months (mean, 20.5 months). All incisions healed by first intention. And no complication such as infection, recurrent rupture, and neurovascular injury occurred. At 1 year after operation, the knee range of motion was (131.0±10.2)°, Lysholm score was 87.4±2.4, Kujala score was 88.3±4.8, the thigh circumference which was measured at 10 cm above the upper end of the patella was (42.58±1.93) cm; all showing significant differences when compared with preoperative values ( P<0.05). The effectiveness results were excellent in 9 cases and good in 3 cases according to the Insall evaluation criteria. The Caton-Deschamps index was 1.09±0.11, which was significantly lower than preoperative one ( t=8.155, P=0.000). Patellar tendon reconstruction with LARS artificial ligament is an effective method for the old patellar ligament rupture, which can effectively repair the knee extension device and restore knee function.

Retrospective Comparative Observational Study of Poly Trauma and Road Traffic Accident (RTA) Injury Case Profile At Visakhapatnam, AP

Retrospective Comparative Observational Study of Poly Trauma and Road Traffic Accident (RTA) Injury Case Profile At Visakhapatnam, AP

Minimally invasive treatment of pilon fracture with single main plate combined with multiple planar screws for support-ing fixation

Objective To explore the clinical effect of minimally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixation. Methods From January 2013 to March 2017, data of 22 patients treated by minimally invasive treatment with single main plate combined with multiple planar screws for supporting fixa-tion were retrospectively analyzed. There were 17 males and 5 females, aged from 23 to 69 years (average, 51.2 years). All cases were closed fractures involving fibula including weight hitting (5 cases), traffic accident (7 cases) and fall injury (10 cases). There were 3 cases of 43-C1 type, 11 cases of 43-C2 type and 8 cases of 43-C3 type according to AO/OTA classification. According to the Ruedi-Allgower classification, there were 5 cases of type Ⅱ and 17 cases of type Ⅲ. Complications were recorded postopera-tively and the articular surface reduction was evaluated using the Burwell-Charnley score. At the last follow-up, Tornetta’s pilon fracture clinical treatment outcome criteria was used to evaluate ankle joint function. Results All the patients were followed up for 13 to 25 months (average, 17.3 months). There were 20 cases of anatomical reduction, 1 case of fair reduction and 1 case of poor reduction according to the Burwell-Charnley score. All the 22 patients were healed with healing time of 3 to 6 months (aver-age, 4.8 months). The efficacy was evaluated according to the evaluation criteria of the clinical treatment results of pilon fracture by Tornetta: excellent in 8 cases, good in 10 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 81.8% (18/22) . All patients had no complications such as wound edge blistering, skin necrosis and infection. Among them, 1 case of internal fixa-tion rejection occurred, and the incision was well healed after removal of the internal fixation after 3 months. Conclusion Mini-mally invasive treatment of C type pilon fracture with single main plate combined with multiple planar screws for supporting fixa-tion not only provides a better anatomical reduction of the articular surface, but also effectively reduces or even avoids incision complications. The long-term clinical results are satisfactory. Key words: Tibial fractures; Fracture fixation, internal; Internal fixators

Spatial analysis of driving accidents leading to deaths related to motorcyclists in Tehran

PurposeTraffic accidents are one of the main causes of death and disability, causing annual deaths of 1.23 million and tens of millions injured people worldwide. Meanwhile, a significant proportion of the deaths and injuries caused by traffic accidents occur among motorcyclists. According to the world health organization's 2015 report, about 25% of deaths from traffic accidents occur in motorists. In Iran, a significant proportion of deaths and injuries result from traffic accidents among motorcyclists, especially in passages within the cities. According to traffic police, about 25% of deaths and 50% of injuries in traffic accidents of Tehran are reported among motorcyclists. Therefore, due to the importance of this issue, the spatial factors influencing the incidence of motorcycle-related accidents in Tehran were investigated using the geographic information system. MethodsThe present work was a cross-sectional and descriptive analysis study. The data necessary for the study were extracted from Tehran traffic police as well as municipality databases. Zoning maps were used to display the distribution of events. In the analytical investigation, Moran index was used to determine the distribution pattern of the events, while Getis-Ord G * statistics were applied to analyze hot spots. To investigate the role of regional and environmental factors in the frequency of traffic accidents related to motorcyclists in geographic units (Tehran 22 districts), Poisson regression and negative binomial models were used. The geographically weighted regression (GWR) model was used to analyze the relationship between environmental factors and the location of these events. Statistical analyses were performed using SPSS, STATA, ARC-GIS and GWR software. ResultsThe southern and eastern margins of Tehran are the most vulnerable areas in terms of deaths related to traffic accidents of motorcyclists. Highways are considered the location of most traffic accidents which lead to death of motorcyclists. Getis-Ord General G * (p < 0.04) indicates that the distribution of high-risk points is statistically significant. The final model showed that in Tehran, the association of different variables including demographic characteristics, pathways network and type of land use with the number of accidents in geographic units was statistically significant. The spatial distribution of traffic accidents leading to deaths of motorcyclists in the center of Tehran varies considerably with changes in population density, length of highways, volume of traffic, and land use in different parts. ConclusionMost of the traffic accidents leading to deaths of motorcyclists occur in highways. Various environmental variables play a role in determining the distribution pattern of these types of events. Through proper traffic management, controlling environmental risk factors and training people the safety of motorcyclists in Tehran can be improved.

Road safety on the example of the city of Bytom

National Road Safety Program 2013-2020 assumes to reduce fatalities by half and seriously injured by 40% from 2010 to 2020. It means that no more than 2,000 people per year should die on Polish roads and no more than 6,900 people should suffer serious injuries in traffic accidents. The experience of other European Union countries with improving road safety gives hope that these goals are still realistic, but there is a need to intensify the activities carried out in this area. In Poland, more and more institutions are taking part in the process of improving road safety: state institutions, non-governmental organizations, local governments, enterprises, scientific and research institutions, the media and many others. The study presents the problem of road safety in the city of Bytom on the basis of its analysis in the years 2013-2017. It discusses the types of road accidents and their classification. Moreover, the paper describes the issues illustrating the situation on roads that have a particular impact on the safety level of road users, among others, the number of road accidents, reasons for their occurrence, the consequences and groups of perpetrators of accidents. It also describes actions and initiatives taken to improve road safety in the city of Bytom.

The Effectiveness of the Primary Trauma Care Courses in West Bank, Palestine: Are the Outcomes Acceptable?

Background: Injuries in all shapes are accounting for more than five million deaths worldwide. Road traffic accidents injuries are the main threat to people and national health systems. Annually, road traffic injuries are resulting in the deaths of more than five million people globally. The Primary Trauma Care Foundation was organized to run the workshop for front-line staff in such countries to attempt and decrease the human and economic consequence of the injury. Methods : A one group pre-test and post-test experimental research design was used. Subjects were invited to complete a multiple-choice question. The overall number of subjects who were taking the primary trauma care course during the period (from Jun 2014 to Oct 2017) was 586 subjects. Results: More than two-thirds of subjects were men and doctors included specialties, physicians and medical students. (90.8%) of participants were carried bachelor's degree. (22.2%) were staff nurses and nurse's students, (1.9%) were midwives. Wilcoxon Signed Ranks Test shows a statistically significant difference between pre and post course score of PTC knowledge (p<0.001). 567 (96.75%) of the participants were shown an improvement after a PTC course. Conclusion: PTC course in Palestine is a valuable and informative course to increase and improve knowledge toward physicians, staff nurses, and midwives. Keywords: Primary Trauma Care (PTC), Effectiveness, Emergency, Palestine. DOI : 10.7176/JEP/10-9-12 Publication date :March 31 st 2019

Limited open reduction and intramedullary fixation for the treatment of refractory femoral subtrochanteric fractures

To explore the surgical technique and clinical effect of limited open reduction and intramedullary fixation assisted with orthopedic traction bed for the treatment of femoral subtrochanteric fractures. From July 2015 to October 2017, 12 patients with femoral subtrochanteric fractures were treated including 9 males and 3 females with an average age of 44 years old ranging from 33 to 67 years old. Among them, 10 cases were on the left trochanter and 2 on the right, and there were 8 cases of highly fall injury and 4 cases of traffic accident injury. All patients received operation at 2 to 5 days after injury. According to the Seinsheimer classification, 8 cases were type IIIA, 2 were type IIIB and 2 were type IV, and all cases were closed injury. The patients were placed on the orthopedic traction bed for trial closed reduction to maintain proper traction before operation. Under C-arm X-ray fluoroscopy, it was advisable to take the fracture end of the main bone block without obvious shortening and shifting. Then limited incision and lengthened InterTan intramedullary nailing were performed, and the Sanders traumatic hip score was used to evaluate the postoperative efficacy. All 12 patients were followed up from 6 to 24 months with an average of 12 months. All cases were received bone healing at 3 to 6 months with an average time of 4 months. According to the Sanders grades, the results were excellent in 9 cases, good in 2 cases and medium in 1 case. Infection, breakage of internal fixation loosening and adverse complications such as malunion were not appeared in all the cases. Limited open reduction assisted with traction bed can be effective to solve the problem of the intraoperative reduction in the complex subtrochanteric fractures, which could save operation time and decrease bleeding. Combined with intramedullary fixation, this method could acquire good counterpoint and stability for the fracture end, and provide a method for the treatment of refractory subtrochanteric fractures.

Seat belts-related behaviors in car drivers with cardiac implantable electronic devices.

Seat belt use is the single most effective means of reducing fatal injuries in road traffic accidents. The presence of a cardiac implantable electronic device (CIED) might influence seat belt-related behaviors due to the physical proximity of the seat belt and left subclavian area in which the device is usually implanted. Understanding the underlying mechanisms of improper seat belt use may improve safety of these patients. We performed a prospective study using a structured questionnaire with 120 CIED recipients (age, 63.9 ± 10.9 years) attending a pacing outpatient clinic. All study participants were active drivers and predominantly male. The majority of patients (79%) had undergone high-energy device implantation. We found that 18% of study participants do not fasten seat belts on a regular basis or use the seat belt in an atypical fashion (such as under the armpit). Moderate or high level of discomfort from the interaction between seat belt and CIED was present in 27%, while more than half (51%) were afraid of seat belt-induced CIED damage. In multifactorial analysis, we found the following independent predictors of improper seat belt use: (1) at least moderate level of discomfort at the CIED site (P=0.02); (2) fear of CIED damage (P=0.009); and (3) irregular seat belt use prior to CIED implantation (P=0.037). Improper seat belt-related behaviors are common in CIED recipients. They arise from previous habits and from CIED-related physical and psychological factors. Patients' education regarding the importance and safety of proper seat belt use is a priority.

Application of high frequency color Doppler ultrasound combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap surgery

To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly. Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects

To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.

Retrospective analysis of pediatric road traffic accidents admitted to the emergency department of a university hospital

Aim: Road traffic accidents are common in our country, but there are not many scientific studies related to childhood road traffic accidents. We aimed to report the frequency of road traffic accidents in children, the demographic characteristics of the patients, the physical effects of accidents on children and their results.Material and Methods: Study data were obtained by retrospective screening of the files of pediatric cases presenting to our emergency department because of road traffic accident between September 2017-2018. The cases were evaluated in terms of age, gender, type of accidents, type of injury, radiologic imaging rates, hospitalization and mortality rates.Results: 377 cases were reviewed. 136 (36.1%) patients were female and 241 (63.9%) were male. 36.9% (n=139) of the admissions were in summer. According to the occurrence of accidents, in-vehicle traffic accidents constituted 61.8% (n=233) of the cases. Among isolated injuries the most common site of injury was head and neck region (n=120, 31.8%). In 81.4% (n=307) of the cases tomography, in 72.1% (n = 273) of cases X-ray, in 25.7% (n=96) of cases ultrasound were requested. 270 (72.2%) patients were discharged from the emergency department with the diagnosis of soft tissue trauma. 58 (15.4%) patients were hospitalized in the respective clinics and 43 (11.4%) patients were hospitalized in the intensive care unit. It was detected that 8 patients (2.1%) died, 4 of them occurred in the emergency department. Conclusion: Pediatric road traffic accidents mostly occur in the summer and most of them are in-vehicle accidents. Boys are more exposed to road traffic accidents. Injuries in traffic accidents mostly locate in the head and neck regions followed by extremities. It was found that tomographic imaging was overused in our study. New strategies should be developed to reduce tomography overuse.

Evaluation of the effect of airbag and seat belt use on the severity of injury in traffic accidents

Evaluation of the effect of airbag and seat belt use on the severity of injury in traffic accidents

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9 305 687 from 2007 to 2016 in Zhengzhou, of which 418 882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups: emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P 0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

Analysis of Cranio-Cerebral Injuries in Fatal Road Traffic Accidents: A Prospective Autopsy Study

Analysis of Cranio-Cerebral Injuries in Fatal Road Traffic Accidents: A Prospective Autopsy Study

Versatile use of the posterior interosseous flap in the reconstruction of complex upper limb defects.

Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented 'in a single study' with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted. We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap. The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/or their parents were satisfied with the postoperative functional and aesthetic improvements. Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

The research progress of miRNA/lncRNA associated with spinal cord injury

In recent years, with the rapid development of economy, the convenient transportation makes people travel more easily. However, the emergence of skyscrapers and various construction projects make high falling injury and traffic accident injury occur frequently, which are the most common types of spinal cord injury. Degeneration of nerve axons after spinal cord injury leads to paralysis of the distal limbs and death. So far, there have been no effective clinical therapy for the recovery of spinal cord function, but animal experiments have made encouraging progress. Recovery process of spinal cord injury involves axonal regeneration and the neural molecular genetic changes in the surrounding environment. Adult animals after spinal cord injury have different degrees of functional recovery in an appropriate growth environment with the benefit of some damaged neurons in the central nervous system. In this paper, we have discussed the changes of miRNA/LncRNA in the progress of regeneration and repair after spinal cord injury.

Toxicological oral fluid results among Spanish drivers testing positive on on-site drug controls from 2013 to 2015

BackgroundDriving under the influence of drugs (DUID) increases the risk of serious injury or death in traffic accidents. The aim of this study was to provide information about DUID in Spanish drivers. Methods10,064 oral fluid samples were collected from Spanish drivers that tested positive on the roadside using the Dräger DrugTest 5000 (DDT5000) between 2013 and 2015. Samples were collected using Quantisal™ and analysed by LC–MS/MS at the Toxicology Laboratory of the Institute of Forensic Science of the University of Santiago de Compostela. ResultsDrivers were mainly young men (85.1% male, 29.7 ± 8.1 years old). In 98.5% of cases, LC–MS/MS results confirmed at least one of the positive results detected on the roadside. Cannabis (82.4%) and cocaine (42.1%) were the most commonly detected drugs. Poly-drug use was observed in 42.7% of drivers, mostly for all illicit drugs (>80%) except for cannabis (42.6%). Illicit drug and single-drug use was more frequent among drivers under 35 years old, and medicines and poly-drug use more common among drivers older than 35 years old. The on-site device performance was calculated using both the DDT5000 cut-offs and the LC–MS/MS method LOQs. Sensitivity (>73% vs >58%), specificity [>94% for all the compounds regardless the cut-offs used, except for cannabis (71%)] and accuracy (>87.5% with both cut-offs) fulfilled the DRUID Project requirements in all cases. ConclusionLC–MS/MS confirmation result was negative in only 1.5% of the cases. The DUID driver profile was a young man, consuming cannabis or a combination of cannabis and cocaine.

One-stage reconstruction of complex soft tissue defects in the hands using multidigit, chimeric, lateral arm, perforator flaps

To describe our experience using microsurgically fabricated, multilobed, chimeric, lateral arm (LA) flaps to reconstruct hand injuries with complex, multidigit, soft tissue defects and to evaluate the morbidity and esthetic and functional outcomes of the donor sites. We performed a single center, retrospective analysis of 21 patients with hand wounds treated from October 2013 to February 2016. All patients underwent reconstruction using multilobed, chimeric, free, LA flaps. A self-reported questionnaire was used to assess donor site morbidity and satisfaction with the esthetic and overall functional result. Outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) score, static 2-point discrimination score, and visual analogue scale. The study included 21 patients (20 males and 1 female), with an average age of 32.14 years (range 18-45 years), who sustained traumatic injuries in road traffic accidents (n = 2) or industrial devices (n = 19). The average DASH score was 28.25 ± 2.3, the average 2-PD score was 7.20 ± 1.30, and the average visual analogue scale (VAS) was 0.38 ± 0.40. All 21 patients had sensory disorders at the donor site. Postoperative donor site complications comprised wound dehiscence (n = 1) and hematoma (n = 3). The patient-rated satisfaction score for the donor site was 5.40 ± 0.90, and 70% of the patients would undergo the same surgery again. Microsurgical fabrication of multilobed, chimeric, LA flaps can exhibit sensory recovery and minimal pain but may cause hematoma and sensory disorders at the donor site. The flaps are a viable alternative for the reconstruction of complex, multidigit, soft tissue defects of the hands.