Traffic Accident Injury Research Articles

Analysis of the demographic and clinical characteristics of hospitalized patients with osteoporotic vertebral compression fractures

Objective To analyzed demographic and clinical characteristics in hospitalized patients with osteoporotic vertebral compression fractures(OVCFs)and to provide certain evidence for prevention and treatment of the disease. Methods Retrospectively analyzedthe clinical data of 2 028 patients with OVCF from January 2009 to December 2018 in the Spine Department of Qilu Hospital of Shandong University. The trend of composition ratio and average age of OVCF patients in the past ten years were observed, the differences of the demographic characteristics and clinical characteristics between different genders as well as the correlation between the number of fractured vertebral bodies of OVCF and various influencing factors were analyzed, and the characteristics of OVCF inpatients were summarized. Results Of 2 028 patients, 374 were males and 1654 were females.The average age was 70.50±9.73 years old, and the male is 73.29±10.23 and the female is 69.87±9.46. A significant increase in the constituent ratio of OVCF between 2009 and 2018 (6.85% in 2009 vs. 13.24% in 2013) and the mean age of OVCF patients increased from 67.54±9.92 years in 2009 to 70.96±9.63 years in 2018were identified.There were significant differences in age distribution of OVCFs in different gender. When the age was less than 70 years old,the fracture ratio of female was higher than that of males, especially between 60 and 70 years old (38.63%∶17.91%); However, when the age was more than 70 years, the fracture ratio of male was higher than that of female especially after 80 years old(29.15%:12.70%). There were significant differences in occupation distribution of OVCFs indifferent gender. Peasants (47.94%), professionals (18.32%) and workers (14.63%) were the top three in female while peasants (35.56%), workers (26.47%) and professionals(20.05%) in male. Falling was the main injury cause of OVCF and there were significant differences in the distribution of causes of OVCF injuries between different genders. The proportion of traffic accident injuries infemaleswas higher than that in maleswhile the proportion of sprains inmaleswas higher than that in females.Moreover,there was a statistically significant difference in the distribution of fracture vertebral bodies between patients of different ages, with or without fracture history and smoking history and different ages of menopause.Among them, the number of fractured vertebral bodies was positively correlated with age(r=0.79, P<0.05).The composition ratio of single vertebral fracture of patients without fracture history, menopausal ageunder 50 and withoutsmoking history was higher than that with fracture history, menopausal age over 50 and with smoking history. On the contrary,the composition ratio of two or more vertebral fractures in patients without fracture history and menopausal agebelow 50 was lower than thatwith fracture history and menopausal ageover 50. Particularly, the ratio of three or more vertebral fractures with smoking history was higher than thatwithout smoking history.The number of patients who adopted bone mineral density(BMD) test and bone turnover maker test was 118 and 106 before 2014 while the number was 568 and 837 after 2014 and the differences were statistically significant. Conclusion The proportion of OVCFs in spine diseases and average age of patients in the period of 2009-2018 was increasing gradually. Distribution of the age,occupation and cause of injury were related to the gender, but there was no correlation between distribution of season, fracture segment and comorbidities and gender. The age, previous fracture history, female menopausal age and smoking history were correlated with the number of fractured vertebral bodies while drinking history was not related. Key words: Osteoporosis; Spinal fractures; Population characteristics; Disease attributes

Application of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs

To investigate effectiveness of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs. Between January 2015 and October 2018, 7 patients with soft tissue defects of the lower limbs were repaired with the anteromedial thigh perforator flaps. The patients were males, aged 8-30 years (median, 23 years). There were 5 cases of traffic accident injuries (the time from injury to admission was 1-4 hours, with an average of 1.5 hours), 1 case of scar formation after traffic accident, and 1 case of scar deformity after burn. The defect located in calf in 5 cases, foot in 1 case, and thigh in 1 case. The area of soft tissue defects ranged from 12 cm×4 cm to 21 cm×7 cm; and the area of flaps ranged from 14 cm×5 cm to 24 cm×8 cm. The donor sites were sutured directly. The flaps survived completely after operation in 6 cases, and the wounds healed by the first intention; the partial necrosis of flap occurred and healed after skin graft repair in 1 case. One incision partially ruptured in the donor site and healed after dressing change; the other incisions healed by the first intetion. All patients were followed up 6 months to 2 years with an average of 9 months. Except 1 case complained of edema of the flap, the other patients had good shape, good color, and no swelling. For patients with soft tissue defects of lower limbs that cannot be repaired with anterolateral thigh perforator flap, the anteromedial thigh perforator flap can be used for good results.

THE CHARACTERISTIC OF PATIENTS WITH FEMORAL FRACTURE IN DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY RSUD DR. SOETOMO SURABAYA 2013 – 2016

Fracture is a neuromuscular damage due to tissue trauma or discontinue of bones. Fractures of the lower limbs due to accidents have the highest prevalence among other fractures in Indonesia. The aim of this study is to determine the characteristic of patients with femoral fracture in Department of Orthopedic RSUD Dr. Soetomo Surabaya.This research is retrospective observational. We analyzed medical records of all stay in patient in Department of Traumatic and Orthopedic RSUD Dr. Soetomo Surabaya during 1 January 2013 – 31 December 2016. Of the 972 enumerated, 112 subjects with femoral fracture were analyzed for study. The observed variable of patients’ profile include: sex, age, cause of fracture, type of wound, location of fracture, place of accident, time of accident.Our observational study during three years has concluded several findings as following. The most common cases of fracture is occurred at the age 15 – 24 with 40 cases (36%). Most of the cases is dominated by male gender (72%). Traffic accident (92%) is the major cause of fracture, which mostly occurred on the street (92%) at 06:01 A.M. until 12:00 A.M (28%). Closed wound (71%) is commonly found in femoral fracture. The most common type of femoral fracture has a closed wound (71%) and located in column of femur (46%). The most common cases of femoral fracture are occurred on male at the productive age due to traffic accident injury.

A CLINICAL STUDY OF BLUNT INJURY ABDOMEN IN TERTIARY CARE HOSPITAL

BACKGROUND : Blunt abdominal trauma is the 3rd most common form of injury in road traffic accidents after orthopaedic injuries and head injuries and the victims mostly are young, productive adults and hence it has got enormous 8 socio-economic impact. METHOD : Aprospective detailed study and analysis of 125 cases of abdominal trauma those admitted in this tertiary care centre over a period of 2 years from 2017 -2019 was undertaken with the review of the medical literature. RESULTS : Blunt injury abdomen is a major cause of morbidity and mortality in young age patients with Road traffic accident being the most common cause. Males are affected more than females. In our study, Liver is most commonly involved organ than spleen which is contrast to literature. CONCLUSION : Early diagnosis reduces the mortality rates and safety measures in roads prevent the injuries , both play a major role in good outcome.

A CLINICAL STUDY OF BLUNT INJURY ABDOMEN IN TERTIARY CARE HOSPITAL

BACKGROUND : Blunt abdominal trauma is the 3rd most common form of injury in road traffic accidents after orthopaedic injuries and head injuries and the victims mostly are young, productive adults and hence it has got enormous 8 socio-economic impact. METHOD : Aprospective detailed study and analysis of 125 cases of abdominal trauma those admitted in this tertiary care centre over a period of 2 years from 2017 -2019 was undertaken with the review of the medical literature. RESULTS : Blunt injury abdomen is a major cause of morbidity and mortality in young age patients with Road traffic accident being the most common cause. Males are affected more than females. In our study, Liver is most commonly involved organ than spleen which is contrast to literature. CONCLUSION : Early diagnosis reduces the mortality rates and safety measures in roads prevent the injuries , both play a major role in good outcome.

IMPLEMENTATION OF THE VIDEO-FIXATION SYSTEM OF VIOLATIONS OF THE DRIVE AT THE RAILWAY MOVEMENTS WITHIN THE FRAMEWORK OF THE PROJECT "SAFETY CITY"

This article is devoted to the decision to ensure traffic safety at railway crossings as part of the Safe City project in the Kyrgyz Republic. Railway crossings are objects of increased danger. Unfortunately, the rules for crossing crossings are not always followed, which leads to injury and death in traffic accidents. In order to completely eliminate the possibility of deaths at crossings, a program is being carried out in Western Europe to reduce the number of crossings and replace them with non-level intersections (using overpasses and tunnels). In the Netherlands, the construction of new crossings is completely prohibited. In Kyrgyzstan, the problem of loss of life on railways is not very acute due to the underdevelopment of railway networks, but nonetheless, propaganda of road safety while passing through level crossings, as well as working with the vulnerable part of road users, should be carried out regularly.

Evolution of high-energy pelvic trauma in southern Finland: a 12-year experience from a tertiary trauma centre

PurposeWe compared incidence, demographics, and injury mechanisms in severely injured patients with and without a pelvic ring fracture treated at a tertiary trauma centre. We also analyzed the changes in injury mechanisms that lead to high-energy pelvic trauma.MethodsData on severely injured adult patients (New Injury Severity Score [NISS] ≥16) from Helsinki Trauma Registry over the years 2006–2017 were reviewed. Patients with a pelvic ring fracture (PRF) and those without (N-PRF) were analyzed. Further subgrouping regarding time of the accident (2006–2009, 2010–2013, 2014–2017) was made. A comparison between groups was performed according to age, age > 60, gender, American Society of Anesthesiologists classification, injury scoring and mechanism, and 30-day in-hospital mortality.ResultsWe included 545 PRF and 1048 N-PRF patients. Pelvic ring fracture patients were more likely to be female (39% vs 22%, p < 0.001), to be more severely injured (NISS 35.2 vs 30.4, p < 0.001), injured due to a high fall (41% vs 25%, p < 0.001), to have self-inflicted injuries (23% vs 8%, p < 0.001), and to have higher 30-day in-hospital mortality (13% vs 9%, p = 0.005). During the study period, we noted increasing mean age and proportion of patients aged > 60, improvement in outcome (shown by decreasing 30-day in-hospital mortality rate) in both groups, and a decrease in motor vehicle accidents (MVAs) leading to pelvic trauma (30–16%).ConclusionsHigh-energy pelvic trauma can no longer be characterized as traffic accident injuries among young men. MVAs leading to pelvic trauma are decreasing and the most common injury mechanism is high fall. The patients are older and often female. Every fourth high-energy pelvic trauma was due to attempted suicide.

Research on damage mechanism and protection of the collision penetration of the thin-walled long rod structure.

Traffic accidents have been closely concerned by the society, and the serious traffic accidents caused by vehicle and guardrail collisions are one of the main manifestations. However, the research in the field of vehicle and guardrail collisions is mainly limited to the waveform guardrail on the expressway, and there is little research on the urban road guardrail, especially in the secondary damage caused by guardrails field. Moreover, the collision between vehicle and the rectangular guardrail of city road is easy to form thin-walled long rod, and it penetrates the driver's chest. To evaluate and analyze the injury results and mechanism of this phenomenon, a penetrating finite element model of chest bone characterized by Chinese human is established using the medical software (MIMICS) and engineering software (HYPERMESH). The model validation is mainly dependent on the corpse impact test. In addition, the software (LS-DYNA) is deployed to simulate the thin-walled long rod penetration. According to the analysis of the "PENETRATION," it is found that the cavity effect produced by the thin-walled long rod through the chest, and the degree of chest damage is related to the speed, angle, weight, and stability of the thin-walled long rod. The difference between the peak value of collision corpse experiment and simulation peak value is less than 5%, which implies that the model is reasonable. Besides, the simulation results also confirm the accident and medical diagnosis cases. As a common form of secondary injury in traffic accidents and a typical case of medical penetrating injury, the thin-walled long rod penetrating injury has important reference value for studies in both directions.

Effect of Age on Severity of Injuries in Traffic Accidents Involving Elderly Drivers

Background: The number of elderly drivers involves in traffic accidents is increasing with the aging of the population. This study aimed to investigate the relationship between the driver's age and injury severity in traffic accidents caused by elderly drivers. Methods: Data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) from 2011-2016 was used to analyze traffic accidents by drivers aged 60 and older. Patients were classified into non-severe and severe injury group. The driver's age was subdivided by 5-year interval to compare the difference in age groups. Multivariate logistic regression was used to identify the factors related to the severe injury. Results: Among a total of 262,361 subjects, 6,427 patients were included, of which 890 (13.9%) were severely injured. There were more male in all age groups. The accidents occurred most in the daytime and general roads. In multivariate analysis, drivers aged 75-79 had 1.39 odds ratio (OR) of severe injury compared to drivers aged 60-64 (95% confidence interval [CI]: 1.06-1.84). Male (OR: 1.71, 95% CI: 1.40-2.09), alcohol intake (OR: 2.02, 95% CI: 1.39-2.94), and non-use of seatbelt (OR: 2.06, 95% CI: 1.71-2.48) were associated with severe injury, as well as the counterpart and road class. Conclusion: Among elderly drivers, there were significant differences in characteristics of traffic accidents according to age groups. The risk of severe injury increased in drivers aged over 75 years comparing to relatively young elderly drivers. These results provide the practical adjustment in determining the age standard when establishing traffic safety policies.

Surgical Outcomes in Depressed Skull Fractures: An Institutional Experience.

Aims:The aim is to study the various factors associated with depressed skull fractures (DSFs) and their relationship with outcomes in patients who underwent surgery.Settings and Design:This was a cross-sectional study in a hospital setting.Patients and Methods:One hundred and fifty patients who underwent surgeries over a period of 6 years at our institute for DSFs were followed up and outcomes were analyzed. Patients having other medical- or trauma-related surgical morbidities were excluded. All age groups were studied.Statistical Analysis Used:The statistical analysis was performed using Chi-square test.Results:There was a significant relationship between the mode of injury, Glasgow coma scale (GCS) score at admission and discharge, and underlying brain injuries with the outcomes. The variables such as pneumocephalus, dural tears, type of fracture and site of the fracture, and age and sex distribution of the patient were not statistically influencing the outcomes.Conclusions:Patients who underwent surgery for DSFs, with good GCS at admission and discharge, with no underlying brain injury, and who did not sustain injuries in a road traffic accident had better outcomes.

Forensic Analysis of 8 Cases on Assessing Traffic Accident Disability Grade of Kümmell's Disease.

Objective To provide a reference for the assessment of the disability grade of Kümmell's disease cases, through the analysis of the basic situation, the disability grade and the causality of Kümmell's disease cases. Methods Data of appraised individuals in 8 cases of Kümmell's disease from traffic accident spinal injury cases accepted by the Institute from 2015 to 2017 were collected, and the basic situation, vertebral fracture sites and disability grades of the appraised individuals were analyzed. Results Among 8 cases of appraised individuals, there were 2 males and 6 females, the oldest 75 years and the youngest 50 years, with an average age of 62.5 years, all of whom suffered from single vertebral fracture. Among them, 1 patient had thoracic 11 vertebra fracture, 3 thoracic 12 vertebra fracture, 2 lumbar 1 vertebra fracture, 1 lumbar 2 vertebra fracture, and 1 lumbar 4 vertebra fracture, all of whom were assessed as grade 10 disability. Conclusion In the assessment of disability grade of vertebral fracture, dynamic observation of the vertebral fracture and its recovery should be made based on imaging data. If it is suspected that there is Kümmell's disease, it should be differentiated from other diseases. Also, the disability grade will be assessed according to the corresponding standards when the morphology of the injured vertebral body is relatively stable.

공개 교통사고 데이터베이스와 기계 학습을 이용한 탑승자의 상해 등급 예측에 관한 연구

In this paper, we propose a prediction model for traffic accident injury grade using machine learning algorithm. We used machine learning models such as Decision Tree, Support Vector Machine, and Logistic Regression to predict injury grade. And to improve performance, Principal Component Analysis(PCA) or Linear Discriminant Analysis(LDA) was applied to each machine learning model. The data used in this study are based on NASS-CDS data that collects traffic accident investigation data and medical records of accident victims. According to the results, the proposed method is expected to be used in the automatic traffic accident notification system because of its reliable accuracy.

One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect

To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.

Clinical Characteristics, Intraoperative Findings, and Surgical Outcomes of Canalicular Laceration Repair with Monocanalicular Stent in Asia.

Purpose To report the epidemiological and clinical data as well as surgical outcomes of canalicular lacerations with Mini-Monoka insertion at a tertiary center in Taiwan and to discuss differences in traumatic pattern, pathogenesis, and surgical outcomes between Taiwan and other countries. Methods From 2009 to 2018, all 48 patients who underwent canalicular laceration repair with Mini-Monoka stent at a tertiary center in Taiwan were retrospectively analyzed. Demographic and clinical data and surgical outcomes were recorded. Results The mean age of the 48 patients was 38 years. Single lower canaliculus was involved in 37 (77.1%) patients, upper canaliculus in 10 (20.8%) patients, and both in 1 (2.1%) patient. The most common etiology was motorcycle accident (41.7%), and all traffic accident injuries accounted for 68.75% of cases. Subgroup classification revealed 64.6% of patients (n=31) were categorized in the deep laceration group, and lower anatomical and functional outcomes were noted in deep laceration. The mean follow-up time was 14.5 months. Overall, the anatomical success rate was 87.5%, and the functional success rate was 91.7% after stent removal. Conclusion Canalicular laceration caused by traffic accidents occurred with a relatively high frequency in Taiwan. Affected patients tended to be middle-aged, and deep laceration accounted for 64.6% of patients. These were contributed by the avulsive eyelid injury mechanism caused by traffic accidents. Furthermore, the deeper lacerated site was located, and the lower anatomical and functional success rates were observed. Early repair after trauma with Mini-Monoka stents achieved good eyelid position (100%) as well as good anatomical (87.5%) and functional (91.7%) success without serious complication.

MORTALITY AND ITS ASSOCIATED FACTORS IN PATIENTS WITH SPINAL CORD INJURIES AT PARAPLEGIC CENTER PESHAWAR, PAKISTAN

OBJECTIVE: to determine mortality and its associated factors in patients with spinal cord injuries (SCI), presenting to Paraplegic Center Peshawar, Pakistan. METHODS: In this retrospective study, clinical records of SCI patients, admitted to Paraplegic Center from January 2011 to March 2017 were evaluated. SCI patients who died during this period, irrespective of their age, gender, duration of SCI and number of readmissions were included in study. Demographic information, clinical characteristic and complications in eligible patients were recorded and analyzed. RESULTS: Out of 62 patients, 46 (74.2%) were males. Mean age of patients was 41.7±17.3 years. Twenty-two (35.5%) patients aged ≤30 years &amp; 20 (32%) patients aged &gt;50 years. The most common cause of SCIs was fall from height (n=23, 37.1%), followed by road traffic accident (n=17, 27.4%) and firearm injury (n=11, 17.7%). About 51.6% of patients (n=32) had complete thoracic paraplegia, 30.6% (n=19) had complete cervical tetraplegia and 8.1% (n=5) had incomplete cervical tetraplegia. Complications and co-morbid conditions included pressure ulcers (n=53; 85.5%), limb fractures (n=7 11.3%), deep venous thrombosis (n=3; 4.8%), hepatitis (n=2; 3.2%) and injury to brachial plexus (n=1; 1.6%). Twenty-two (35.5%) patients underwent spine fixation surgery while forty (64.5%) patients were managed conservatively. Majority of the patients (n=51, 82.3%) died within the first year of SCI. CONCLUSION: Relatively younger patients were predominant and complete thoracic paraplegia was the commonest SCI level. Presence of pressure ulcers, limb fractures and deep venous thrombosis in patients with SCI were major contributing factors to morbidity leading to mortality in our patients.

Prediction of probability of fatality due to brain injury in traffic accidents

Objective: Fatal brain injuries result from physiological changes in brain tissues, subsequent to primary damage caused by head impact. Although efforts have been made in past studies to estimate the probability of brain injury, none of them involved prediction of such physiological changes. The goal of this study was to evaluate the fatality prediction capability of a novel approach that predicts an increase in intracranial pressure (ICP) due to primary head injury to estimate the fatality rate using clinical data that correlate ICP with fatality rate.Methods: A total of 12 sets of head acceleration time histories were used to represent no, severe, and fatal brain injury. They were obtained from the literature presenting head kinematics data in noninjurious volunteer sled tests or from accident reconstruction for severe and fatal injury cases. These were first applied to a Global Human Body Models Consortium (GHBMC) head–brain model to predict nodal displacement time histories of the brain, which were then fed into FEBio to predict ICP. A Weibull distribution was applied to the data for the relationship between fatality rate and ICP obtained from a clinical paper to estimate fatality rate from ICP (procedure A). Fatality rate was also estimated by applying the temporal and spatial maximum value of maximum principal strain (MPSmax) obtained from the GHBMC simulation to an injury probability function for MPSmax (procedure B). Estimated fatality rates were compared between the 2 procedures.Results: Both procedures estimated higher average fatality rate for higher injury severity. The average fatality rate for procedure A without ischemia representation and procedure B was 72.4 and 51.0% for the fatal injury group and 8.2 and 21.7% for the severe injury group, respectively, showing that procedure A provides more distinct classification between fatal and nonfatal brain injury. It was also found that representation of ischemia in procedure A provides results sensitive to injury severity and impact conditions, requiring further validation of the initial estimate for the relationship between brain compression and ischemic cell death.Conclusions: Prediction of the probability of fatality by means of a combination of simulations of the primary brain deformation and subsequent ICP increase was found to be more distinct compared to the prediction of primary injury alone combined with the injury probability function from a past study in the select 12 head impact cases.

A Qualitative Research on the Treatment Experiences of Patients with Serious Injury in Traffic Accidents Treated with Traditional Korean Medicine

A Qualitative Research on the Treatment Experiences of Patients with Serious Injury in Traffic Accidents Treated with Traditional Korean Medicine

Traumatic spine injury in Kashan, Iran

Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma center in Kashan, Iran. Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was used to collect demographic characteristics (age, gender, education, marital) and mechanism of the injury of the spine. According to ICD-10, the level of the injury was detected by diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed tomography scans, and also multi-trauma final outcome of the patients with traumatic spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery treatment was investigated. Results: The number of patients with traumatic spine injuries was 986. Among this batch, 77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in the age group of 15 to 30 years. Traffic accident was the most common mechanism of the trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%. Conclusion: The TSI is an important and serious public health problem and a major cause of disability. Understanding the epidemiology can help us contrive appropriate preventative measures.

Clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar defect of ankle

Objective: To explore the clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar skin and soft tissue defect of ankle. Methods: From September 2015 to September 2017, 10 patients with lacunar skin and soft tissue defects of ankle were hospitalized in our unit, including 7 males and 3 females, aged 17-62 years, 8 traffic accident injuries and 2 heavy body pressure injuries. After debridement, the wound area ranged from 7 cm×4 cm to 15 cm×9 cm, and the lacunar area ranged from 3.0 cm×2.0 cm×1.0 cm to 7.0 cm×4.0 cm×2.0 cm. The defect was repaired with island composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel and partial gastrocnemius muscle at stage Ⅰ. The area of flaps ranged from 8 cm×5 cm to 16 cm×10 cm, and the area of gastrocnemius muscle flaps ranged from 4 cm×3 cm to 8 cm×5 cm. The donor site was repaired with ipsilateral thigh intermediate split-thickness skin graft or sutured directly. The location of vascular pedicle, survival of tissue flap, follow-up, and occurrence of complications were recorded. Results: The vascular pedicle of this group of cases was located 5-15 cm above the lateral malleolus. The tissue flaps of 10 patients survived completely after operation at stage Ⅰ. Follow-up for 1-12 months showed that the area repaired with tissue flaps had good color, blood supply, and texture, without ulceration, and recovered different degrees of pain sensation and deep tactile sensation, and no short-term or long-term complications occurred. Conclusions: The double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle has good blood supply, which can effectively fill the invalid space in repairing lacunar skin and soft tissue defect of ankle, with good effect after operation, and it is worthy of clinical application.

Evaluation and prediction of diffuse axonal injury based on optimization strategy in vehicle collision accidents

The brain is one of the most critical parts of the human body, and it is vulnerable in vehicle collision accidents. Statistically, traumatic brain injuries (TBIs) account for about half of the 1.3 million deaths and 50 million injuries in annual road traffic accidents around the world. However, there are currently no universally accepted and specialized criteria for the different types of brain injuries, even though a series of injury criteria has been presented using mathematical combinations of kinematic parameters. To reduce TBIs and improve the safety performance of vehicles, we established a new brain injury index (BII) by maximizing the correlation between the kinematic parameters and strain-based measures such as cumulative strain damage measure (CSDM) and maximum principal strain (MPS), which employed 218 crash test data and the simulated injury monitor (SIMon) model from the National Highway Traffic Safety Administration website. In the process of establishing the BII, we combined the K-Nearest Neighbor with quadratic regression to enhance the correlation between the kinematic metrics and CSDM/MPS by eliminating the influence of some outlier data and used the genetic algorithm to obtain the optimal weight ratios of several kinematic parameters with strong correlations. The assessment capability of the proposed BII was more superior and reliable than other indexes when compared with 15 existing kinematic-based criteria. Finally, we developed a simple BII (SBII), which ignored the influence of the translational velocity and acceleration, and used it to establish three prediction models of brain injury based on artificial neural network learning, which achieved the quantitative description of the relationship between the kinematic parameters and CSDM/MPS.