Traffic Accident Injury Research Articles

Effectiveness of rigid interlocking nails through tip of greater trochanter for fixation of femur shaft fracture in adolescent

To explore the effectiveness of rigid interlocking nails through the tip of the greater trochanter for fixation of femur shaft fracture in adolescent. A retrospective analysis was made on the clinical data of 23 adolescents with femoral shaft fractures treated between June 2011 and June 2015. Of 23 cases, 19 were male and 4 were female, aged from 13 years and 6 months to 17 years (mean, 15.2 years), weighed from 40 to 77 kg (mean, 53.5 kg). The causes were traffic accident injury in 13 cases, sports injury in 7 cases, and falling injury in 3 cases. Fracture located at the proximal 1/3 in 6 cases, middle 1/3 in 10 cases, and distal 1/3 in 7 cases; fracture was typed as transverse in 10 cases, oblique in 6 cases, spiral in 1 case, and comminuted in 6 cases. The course of disease was 3-17 days (mean, 6.2 days). At last follow-up, the leg length discrepancy, femoral neck shaft angle, femoral neck diameter, and articulotrochanteric distance (ATD) were measured on the X-ray films. Wounds healed in all patients, and no infection occurred. All patients were followed up 15-36 months (mean, 26.5 months). The patients had no pain and had normal gait, without lameness. The X-ray films showed bone healing at 5-13 months (mean, 6.5 months). No nonunion, delayed union, malunion of more than 5 °, or rotational deformity occurred. The removal time of internal fixations was 12-24 months (mean, 19.5 months) after operation. No heterotopic ossification, re-fracture, proximal femoral deformity, or femoral head necrosis occurred during follow-up. Two patients had early epiphyseal closure of greater trochanter, which had no impact on gait; leg-length inequality of less than 1 cm was observed in 2 cases. At last follow-up, the neck shaft angle, femoral neck diameter, and ATD of normal and affected sides were (131.7±6.3) and (132.9±7.8)°, (34.1±3.2) and (33.9±3.8) mm, and (27.8±9.2) and (26.5±8.5) mm, showing no significant difference between two sides ( t=-0.24, P=0.86; t=0.18, P=0.92; t=1.03, P=0.49). It is a reliable and effective method to use rigid interlocking nails inserted through the tip of the greater trochanter for the fixation of femur shaft fracture in adolescent.

Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures

To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case. Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.

Ligation of the Left Hepatic Duct and Proper Hepatic Artery Following a Traffic Accident Injury.

A 32-year-old man was admitted to our hospital due to a traffic accident. Intraoperative observations revealed hemoperitoneum, splenic transection, pancreatic tail contusion, comminuted injury in the porta hepatis, rupture in the left hepatic duct, an irregular crevasse in the ductus hepaticus communis, the caudate lobe was transversely broken on the left, and under the gap, there was a fracture in retrohepatic inferior vena cava with huge retroperitoneal hematoma. We carried out a ligation of the left hepatic duct and the proper hepatic artery. Postoperation, the man recovered smoothly. At 5years and 5months postoperation, MRI showed that the left liver had atrophied partly. So, we consider that the ligation of the left hepatic duct is a safe procedure for patients without cirrhosis under the conditions of ligation of the proper hepatic artery.

Clinical application of changeable cross-leg style sural neurovascular flap in repairing contralateral fairly large soft tissue defect on dorsum of forefoot

To explore the effectiveness of changeable cross-leg style sural neurovascular flap in repairing contralateral fairly large soft tissue defects on dorsum of forefoot. Between June 2006 and June 2015, 12 patients with fairly large soft tissue defect on dorsum of forefoot were treated. There were 8 males and 4 females, with an average age of 35.6 years (range, 18-57 years). Defects were caused by traffic accident injury in 4 cases, machine crush injury in 3 cases, and heavy object crush injury in 3 cases, with a median disease duration of 11 days (range, 5 hours to 28 days) in the 10 cases; the defect cause was atrophic scar in 2 cases, with disease duration of 2 years and 3 years respectively. The wound size of soft tissue ranged from 6.2 cm×4.1 cm to 11.5 cm×7.4 cm; combined injuries included tendon exposure in all cases and bone exposure in 6 cases. The changeable cross-leg style sural neurovascular flaps were used to repair defects. The width and length of flap pedicle were increased. The cross-leg position was maintained with the elastic net bandage. The size of flaps was 16 cm×7 cm to 21 cm×11 cm, with a pedicle of 8-16 cm in length and 5-6 cm in width. After operation, 10 flaps survived, and wound healed by first intention. Extravasated blood occurred at the flap edge in 2 cases and was cured after symptomatic treatment. No pressure sore occurred. All patients were followed up 3-24 months (mean, 7 months). The appearance and function of the affected legs were good, and the flaps had soft texture and normal color. Changeable cross-leg style sural neurovascular flap can achieve good effectiveness in repairing fairly large soft tissue defect on dorsum of forefoot. Some drawbacks of single cross-leg style can be avoided.

A population-based study on epidemiology of intensive care unit treated traumatic brain injury in Iceland.

Traumatic brain injury is a worldwide health issue and a significant cause of preventable deaths and disabilities. We aimed to describe population-based data on intensive care treated traumatic brain injury in Iceland over 15 years period. Retrospective review of all intensive care unit admissions due to traumatic brain injury at The National University Hospital of Iceland 1999-2013. Data were collected on demographics, mechanism of injury, alcohol consumption, glasgow come scale upon admission, Injury Severity Scoring, acute physiology and chronic health evaluation II score, length of stay, interventions and mortality (defined as glasgow outcome score one). All computerized tomography scans were reviewed for Marshall score classification. Intensive care unit admissions due to traumatic brain injury were 583. The incidence decreased significantly from 14/100.000/year to 12/100.000/year. Males were 72% and the mean age was 41 year. Majority of patients (42%) had severe traumatic brain injury. The most common mechanism of injury was a fall from low heights (36.3%). The mortality was 18.2%. Increasing age, injury severity score, Marshall score and acute physiology and chronic health evaluation II score are all independent risk factors for death. Glasgow coma scale was not an independent prognostic factor for outcome. Incidence decreased with a shift in injury mechanism from road traffic accidents to falls and an increased rate of traumatic brain injury in older patients following a fall from standing or low heights. Mortality was higher in older patients falling from low heights than in younger patients suffering multiple injuries in road traffic accidents. Age, injury severity score, acute physiology and chronic health evaluation II score and Marshall score are good prognostic factors for outcome. Traumatic brain injury continues to be a considerable problem and the increase in severe traumatic brain injury in the middle age and older age groups after a seemingly innocent accident needs a special attention.

A Novel Multilevel-SVD Method to Improve Multistep Ahead Forecasting in Traffic Accidents Domain

Here is proposed a novel method for decomposing a nonstationary time series in components of low and high frequency. The method is based on Multilevel Singular Value Decomposition (MSVD) of a Hankel matrix. The decomposition is used to improve the forecasting accuracy of Multiple Input Multiple Output (MIMO) linear and nonlinear models. Three time series coming from traffic accidents domain are used. They represent the number of persons with injuries in traffic accidents of Santiago, Chile. The data were continuously collected by the Chilean Police and were weekly sampled from 2000:1 to 2014:12. The performance of MSVD is compared with the decomposition in components of low and high frequency of a commonly accepted method based on Stationary Wavelet Transform (SWT). SWT in conjunction with the Autoregressive model (SWT + MIMO-AR) and SWT in conjunction with an Autoregressive Neural Network (SWT + MIMO-ANN) were evaluated. The empirical results have shown that the best accuracy was achieved by the forecasting model based on the proposed decomposition method MSVD, in comparison with the forecasting models based on SWT.

Evaluation of Influencing Factors and commonly Involving Side in Maxillofacial Injuries in Road Traffic Accidents by Motorized Two Wheelers: A Cross-sectional Study

ABSTRACT Introduction Trauma remains to be a leading cause of maxillofacial injury globally. Motorized two wheelers (MTWs) are the main cause of (73%) maxillofacial injuries in the road traffic accidents; in several studies, the right side of maxillofacial injuries was reported as the common side of injury than left side. In our previous study, the percentage of the right side injuries was higher than the left side. Aim The aim of this study is to evaluate the influencing factors of the maxillofacial injury by MTWs and to find the association between the side maxillofacial injuries and the handedness of drivers. Materials and methods Clusters sampling method was used; 20 clusters were selected in Chennai. Motorized twowheeler drivers were selected. Data collected by prepared questionnaires’ were statistically analyzed. Data included the demographic details, type of vehicle, engine capacity, average driving speed, years of driving, regular usage of the helmet, type, mode and frequency of accident, management, influence of alcohol, and use of the helmet at the time of injury. The side of the facial injury and handedness of drivers were recorded. Results From the total of 721 participants, 75.7% were males, 24.3% were females; 46.74% were in the age of 18 to 25; mean age is 29.45. Bikes were 55.9%, scooter 38.2%, moped 8.3%; 59.9% are geared; 50.5% were 80 to 100 cc vehicles types and 37% were 110 to 150 cc types; 62% of male's average speed is 80 km/hour; 53% of female's average speed is less than 40 km/hour. Only 18.06% had used at the time of injury. 39.4% of females had accidents, males had 59.3% (p < 0.0001). Two-wheeler vs two-wheeler accidents were 24.8%; two-wheeler vs four wheeler were 19%; by pedestrians crossing 18.7%; by animal crossing was 16.5%; skid two wheeler 20%. A total of 30.02% were under the influence of alcohol. Right-side injuries were 44.5%; left side 25.9% (p < 0.0001), while 96.9% were right-handers. Conclusion Right-side injuries were common in MTW skid and fall. Speed, type of vehicle, handedness, influence of alcohol, use of helmet, mode of injury, all are the determining factors for pattern and severity of injury. Helmet usage would definitely minimize the head injury to some extent. How to cite this article Mohanavalli S, Thinakaran M, Bala GSV. Evaluation of Influencing Factors and commonly Involving Side in Maxillofacial Injuries in Road Traffic Accidents by Motorized Two Wheelers: A Cross-sectional Study. World J Dent 2017;8(1):49-54.

Epidemiological Study of Patterns of Head Injuries in Fatal Road Traffic Accidents in Tripura

Road traffic accidents have become significantly responsible for loss of life, economic and social resources even in our small state of Tripura. With the sudden rise in the number of vehicles in the past ten years the chances of traffic accidents also has risen. The present study has been carried out in the Mortuary of Department of Forensic Medicine and Toxicology, AGMC & GBP Hospital on all the autopsies performed in fatal Road traffic accident cases during the period of 1July 2011 to 30th June 2013 to highlight the patterns of head injuries among road traffic accident victims in this part of the state. Most of the victims in the present study were males and belong to the age group of 21 to 30 years. Most commonly affected victims were the pedestrians with a total number of 84(42.85%) cases. Majority of the victims died within 24 hours of the incident with a total number of 135 (68.87%) cases. Mechanized four wheelers were the most common offending vehicles with a total number of 102 (52.04%) cases. Commonest external injury sustained was contusion with a total number of 180 (91.83%) cases. Skull bone fracture was found in total 96 cases. Subdural haemorrhage was the most common type of intracranial haemorrhage with a total number of 181(92.34%) cases followed by subarachnoid haemorrhage with a total number of 149 (76.02%) cases. Brain contusion is the most common injury encountered by the victims. This study will help in improving data linkages between police, transport and health services.

Utilization of drugs in patients with road traffic accident injuries

Background: Drug utilization studies provide information on pattern of drug prescribing and consumption, occurrence of delayed adverse effects, cost influenced sales, and the volume of prescriptions having social, economic, and medical significance. Objective: The present study was designed with an objective to evaluate drug utilization in this field of pharmaceutical care. Materials and Methods: The present study was a retrospective, qualitative, cross-sectional, drug utilization study carried out for 1 year in Accident and Emergency Department of Khoula Hospital. Results: Results of the present study indicate that majority of patients complained dizziness by 24% and pain with 50%. Most common antibiotics used in prophylaxis and treatment were amoxiclav, cefuroxime, and ceftriaxone injections. As some cases complained of severe pain, they had received paracetamol, ibuprofen, diclofenac, and tramadol. The tetanus toxin injection was given as prophylaxis in 27.9% of cases against poisoning from entry of foreign bodies. Metoclopramide and promethazine are medications given to relieve nausea and vomiting. Analysis of results on use of medications for pain management has shown a significant (P < 0.01) correlation with road traffic injuries. Conclusion: We conclude from this study that majority of patients visiting accident are noted to have minor complications due to road traffic accidents (RTAs) and are treated successfully with most common and safe medications. However, we recommend future extensive studies considering the patients admitted to Inpatient Department and Intensive Care Unit to get clear information on pharmaceutical care provided to manage RTA and their complications.

A New Approach in Improving Traffic Accident Injury Prediction Accuracy

A New Approach in Improving Traffic Accident Injury Prediction Accuracy

A New-born with Severe Hydrocephalus and Myelomeningocele Associated with Maternal Antiepileptic Medication: A Case Report

The possible teratogenic effects of maternal antiepileptic drugs (AEDs) on the development of the fetus are of major concern. The fetal risks imposed by these drugs must be weighed against the risks associated with untreated maternal epilepsy not being treated. Here, we describe an infant with a neural tube defect caused by AEDs prescribed to the mother during her pregnancy. A female infant was delivered by means of cesarean section after 37+6 weeks of gestation. Her 21-year-old mother had been diagnosed with epilepsy at 2 years of age, following brain surgery performed for a traffic accident injury. Since the age of 6 years, the mother had been medicated with lamotrigine (Lamictal®), levetiracetam (Keppra®), and valproate (Depakote®). At birth, the baby exhibited pallor, severe macrocephaly, a large anterior fontanelle (4 cm × 4 cm), and sutural widening. On her lower back, there was a 3 cm open spinal dysraphism exposing nervous tissue. On the 11th postnatal day, a ventriculo-peritoneal shunt was placed and a myelomeningocele removal operation was performed. After this operation, the head circumference decreased from 44.0 cm to 35.8 cm, and the post-operative period was uneventful. The patient was discharged on the 24th day. Several case reports and studies have reported that valproate or multi-antiepileptic medication that contains valproate increased the risk of neural tube defects in the offspring. For women of childbearing age who use AEDs, clinicians should review pregnancy risk regularly and consider adjusting medication whenever possible. Additionally, while examing newborns with neural tube defects, clinicians should review prenatal maternal medication history thoroughly.

소비자 맞춤형 개념설계 및 쿠션부 충격해석을 통한 외피형 에어백 헬멧 개발

This study was initiated to minimize head injuries, which is the largest cause of increased external activity, traffic accident injuries, and death. We developed a low cost airbag that can be covered by a safety helmet based on consumer needs. The results of the survey showed that safety is the most important aspect of consumers' safety helmets. It also predicted that increasing the weight would present the biggest problem. Curved airbag cushion parts that can be attached to a helmet and the sensor part of a block type were designed. Impact analysis was performed by specifying the pressure inside the airbag and the volume of the airbag as variables.

Linear Frontal Bone Fractures - Clinical and Surgical Profile: A Retrospective Study

Background: Linear frontal bone fractures are common injuries in road traffic accidents. Pneumocephalus and CSF (cerebrospinal fluid) leak are both factors influencing their outcome. Persistent pneumocephalus and CSF leak are main indications for surgical treatment. Objectives: Surgical indications are rarely discussed in linear frontal bone fractures. We report results on patients with linear frontal bone fractures, clinical data, management, surgical indications and outcome. Methods: From 2011 to 2015, 121 patients were admitted to our institution with a diagnosis of frontal bone fractures (compound depressed fractures excluded). Fractures were classified into three types, Type A: fracture involving anterior wall of the frontal sinus; Type B: fracture involving posterior wall of the frontal sinus and Type C: fracture of frontobasal region without involving the frontal sinus. All patients were followed for more than 6 months. Results: A total of 112 patients were conservatively treated with standard pneumocephalus protocol. Nine patients underwent surgical intervention. The indications for surgery were the presence of persistent pneumocephalus in CT scan and persistent CSF leak. The presence of pneumocephalus or CSF leak in Type B patients sinus cranialisation with repair of the defect were the variables mainly influencing the outcome (P < 0.001). Conclusions: Frontal bone fracture needs careful attention to prevent its complications such as a CSF leak and meningitis. Patients need clinical and radiological evaluation. Patients with persistent CSF leak or pneumocephalus should always be treated surgically and others should be managed conservatively

Clinical study of ocular injuries in road traffic accidents

Clinical study of ocular injuries in road traffic accidents

REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY

To investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. Between September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. Nine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. The medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.

REPAIR OF ANKLE SKIN AND SOFT TISSUE DEFECT WITH FREE SUPERFICIAL ILIAC CIRCUMFLEX ARTERY PERFORATOR FLAP

To investigate the effectiveness of free superficial iliac circumflex artery perforator flap for repair of foot skin and soft tissue defect. Between January 2010 and December 2015, 16 patients with ankle skin and soft tissue defect were treated. There were 13 males and 3 females with an average age of 32 years (range, 5-56 years). The causes included traffic accident injury in 8 cases, machinery injury in 3 cases, falling injury in 3 cases, and electrically injury in 2 cases. The time from injury to hospital was 1 to 6 hours (mean, 3.5 hours). The wound sites included foot dorsum skin defect in 6 cases, ankle skin defect in 5 cases, the back foot and ankle skin defect in 5 cases. The skin defect size ranged 5 cm×4 cm to 16 cm×7 cm. All patients had tendon exposure, and 8 patients had fracture. An emergency repair was performed in 6 cases, and selective surgery in 10 cases. The free iliac circumflex artery perforators flap was used to repair defect; the flap size was 6 cm×5 cm to 17 cm×8 cm, and the flap thickness was 0.4 to 1.1 cm (mean, 0.8 cm). The flaps survived in the other 15 patients with primary healing of wounds except 1 patient because the iliac circumflex artery was too small to provide good blood supply, who underwent repair with local skin flap. Incision at donor site healed by first intention. The 15 cases were followed up 6-24 months (mean, 13 months). The appearance of the foot was satisfactory, and the flap had good texture without bulky flaps. Free iliac circumflex artery perforators flap is one of ideal flaps in repair of skin defect of the foot and ankle because of hidden donor site, reliable blood supply, less injury to donor site, and full use of the flap.

ILIAC FLAP COMBINED WITH ANTEROLATERAL THIGH FLAP FOR REPAIR OF FIRST METATARSAL BONE AND LARGE SKIN DEFECT

To investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. Between January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. After operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. The iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.

ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR

To evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament (PCL) tibial eminence avulsion fractures associated with meniscus posterior horn tear. Between January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopically treated with polyester suture and hollow screw fixation. There were 10 males (10 knees) and 11 females (11 knees), aged 14-53 years (mean, 35.7 years). The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL avulsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee (IKDC) score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days (mean, 10 days). The operation time was 60-100 minutes (mean, 75 minutes). Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months (range, 12-46 months). The results of posterior drawer test were negative in 19 cases, and positive in 2 cases (having hard end point). Tibial sink disappeared. At last follow-up, X-ray film showed good healing of fracture, and no displacement. The patients had no locking knee, snapping or tenderness of joint space, and the Mcmurray sign was negative; the IKDC score and Lysholm score were significantly improved to 92.0±2.5 and 92.7±2.6 respectively (t=-39.903, P=0.000; t=-43.242, P=0.000). The range of motion was normal in 20 patients (0-130°) except 1 patient having limited flexion (0-80°), whose range of motion returned to 0-120° after release. The arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.

Maxillofacial Injuries in Women: A Retrospective Study of 10Years.

Diversities exists in incidence, etiology and epidemiology of facial fractures among male and female individuals due to various reasons. Many of the epidemiological studies published during the millennium have shown male predilection. This study was carried to evaluate the etiology, patterns and distribution of facial fractures among different age groups in women. This Retrospective epidemiological study dealt with a total of 302 women with 422 fractures in maxillofacial region during a period of June 1st 2005 to May 31st 2015 at Mamata Dental College and Hospital, Khammam, Telangana, India. Mean age of incidence was 31.58years, mandibular fractures were highest (44.07%) followed by zygomaticomaxillary complex injuries (ZMC) (20.37%). Road traffic accidents (RTA) injuries (53.7%) were highest, followed by assault (23.9%) and other causes. Highest number (33.8%) of fractures were sustained in the 3rd decade and least (0.7%) in the 8th decade of life. Among soft tissue injuries most commonly seen were lacerations (51%). Results of this study suggest that there is an increase in the number of maxillofacial injuries in women, representing changes in the society, exposing women to similar conditions like men and increased number of working women. This study helps to identify trauma burden, assess the awareness of current preventive measures, women protection laws, for instituting new guidelines for prevention and planning health care services for women.

POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS

To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.