Injury Rates Research Articles

Effectiveness of exercise-based sports injury prevention programmes in reducing injury rates in adolescents and their implementation in the community: a mixed-methods systematic review

ObjectiveDespite evidence supporting the efficacy of sport injury prevention programmes (SIPPs) in adolescents, implementation of SIPPs in community settings is low. This review aims to synthesise and integrate evidence on...

Characteristics of Intracranial Injuries in Pediatric Patients Following Blunt Head Trauma.

Pediatric head trauma is a frequent reason for presentation to the emergency department. Despite this, there are few reports on specific characteristics and injury patterns in head injured children. The goal of this study was to evaluate head injury patterns in children with blunt head injury and their prevalence by age group. This is a planned secondary analysis of the NEXUS II Head CT validation study. Consecutive patients with blunt head trauma were enrolled between 2006 and 2015. Demographics and criteria from 2 clinical decision instruments (NEXUS and Canadian Head CT rules) were gathered at the time of enrollment. We abstracted and cataloged injuries for pediatric patients based on radiologist report. Frequencies of injuries and severity were analyzed by developmental age group. A total of 1018 pediatric patients were enrolled, 128 (12.6%) of whom had an injury on computed tomography scan. Median age was 11.9 (Interquartile range 4.5-15.5) for all patients and 12 (4.8-15.5) for injured patients. Of injured patients, 49 (38.3%) had a significant injury, and 27 (21.1%) received an intervention. Teenagers had the highest rate of significant injury (50%) and intervention (30%). Injuries were most frequently noted in the temporal (46.1%), frontal (45.3%), and parietal (45.3%) regions. Subarachnoid hemorrhage (29.7%) and subdural hematoma (28.9%) were the most common injuries observed.Intraparenchymal hemorrhage and cerebral edema were more prevalent in older age groups. The most common injury mechanism overall was fall from height (24.7%). Motor vehicle accidents and nonmotorized wheeled vehicle accidents were more common in older patients. Serious injuries requiring intervention were rarely encountered in pediatric patients experiencing blunt head trauma. Mechanisms of injury, type of injury, and rates of intervention varied between developmental age groups.

Hysterectomy Techniques and Outcomes for Benign Large Uteri: A Systematic Review.

To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint. PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible. This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy. The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18-60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29-70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52-22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07-37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss. Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time. PROSPERO, CRD42021233300.

Monotherapy versus combination for the treatment of Stenotrophomonas maltophilia: a multicenter cohort study

ABSTRACT Background The aim of this study was to compare the safety and effectiveness of monotherapy versus combination therapy for the treatment of infections caused by S. maltophilia. Methods This retrospective, multicenter, cohort study included patients treated with either monotherapy or combination therapy for infections caused by S. maltophilia. Primary outcomes included overall in-hospital mortality, 30-day mortality, and clinical cure. Safety outcomes were also evaluated. Multivariable logistic regression was used as a control for confounding variables. Results A total of 407 patients were included, 330 patients received monotherapy and 77 patients received combination therapy. A total of 21% presented with concomitant bacteremia. After adjusting the differences between the two groups, there were no statistically significant differences between patients who received monotherapy versus combination therapy in clinical cure (55% vs 65%; OR, 0.72; 95% CI, 0.40–1.31) and overall in-hospital mortality (52% vs 49%; OR, 0.84; 95% CI, 0.45–1.57). However, patients who received monotherapy had a lower rate of 30-day mortality (28% vs 32%; OR, 0.45; 95% CI, 0.22–0.90) and acute kidney injury (9% vs 18%; OR, 0.35; 95% CI, 0.16–0.78). Conclusion Clinical outcomes did not significantly differ in patients who received combination therapy versus monotherapy. More data are needed to validate these findings.

A joinpoint analysis examining trends in firearm injuries at six us trauma centers from 2016 to 2022

BackgroundThere is an epidemic of firearm injuries in the United States since the mid-2000s. Thus, we sought to examine whether hospitalization from firearm injuries have increased over time, and to examine temporal changes in patient demographics, firearm injury intent, and injury severity.MethodsThis was a multicenter, retrospective, observational cohort study of patients hospitalized with a traumatic injury to six US level I trauma centers between 1/1/2016 and 6/30/2022. ICD-10-CM cause codes were used to identify and describe firearm injuries. Temporal trends were compared for demographics (age, sex, race, insured status), intent (assault, unintentional, self-harm, legal intervention, and undetermined), and severity (death, ICU admission, severe injury (injury severity score ≥ 16), receipt of blood transfusion, mechanical ventilation, and hospital and ICU LOS (days). Temporal trends were examined over 13 six-month intervals (H1, January–June; H2, July–December) using joinpoint regression and reported as semi-annual percent change (SPC); significance was p < 0.05.ResultsFirearm injuries accounted for 2.6% (1908 of 72,474) of trauma hospitalizations. The rate of firearm injuries initially declined from 2016-H1 to 2018-H2 (SPC = − 4.0%, p = 0.002), followed by increased rates from 2018-H2 to 2020-H1 (SPC = 9.0%, p = 0.005), before stabilizing from 2020-H1 to 2022-H1 (0.5%, p = 0.73). NH black patients had the greatest hospitalization rate from firearm injuries (14.0%) and were the only group to demonstrate a temporal increase (SPC = 6.3%, p < 0.001). The proportion of uninsured patients increased (SPC = 2.3%, p = 0.02) but there were no temporal changes by age or sex. ICU admission rates declined (SPC = − 2.2%, p < 0.001), but ICU LOS increased (SPC = 2.8%, p = 0.04). There were no significant changes over time in rates of death (SPC = 0.3%), severe injury (SPC = 1.6%), blood transfusion (SPC = 0.6%), and mechanical ventilation (SPC = 0.6%). When examined by intent, self-harm injuries declined over time (SPC = − 4.1%, p < 0.001), assaults declined through 2019-H2 (SPC = − 5.6%, p = 0.01) before increasing through 2022-H1 (SPC = 6.5%, p = 0.01), while undetermined injuries increased through 2019-H1 (SPC = 24.1%, p = 0.01) then stabilized (SPC = − 4.5%, p = 0.39); there were no temporal changes in unintentional injuries or legal intervention.ConclusionsHospitalizations from firearm injuries are increasing following a period of declines, driven by increases among NH Black patients. Trauma systems need to consider these changing trends to best address the needs of the injured population.

Adding injury to insult: Unfair treatment at work and occupational injury among hospital patient-care workers.

Hospital patient-care workers have high occupational injury rates. While physical hazards within hospital work environments are established determinants of injury, social exposures may also contribute. This study examined how reports of unfair treatment at work, a dimension of work-related experiences of discrimination, were associated with injury among hospital-based patient-care workers. We used data from the Boston Hospital Workers Health Study, a longitudinal cohort of nurses and nursing assistants at two Boston-area hospitals. In 2018, we conducted a worker survey asking about three types of unfair treatment at work and occupational injuries during the past year. We used mixed-effects logistic regression models to evaluate associations between specific types, total load, and high-frequency exposure of unfair treatment with injury, adjusting for age, gender, race and ethnicity, job title, and unit type. Among 1001 respondents, 21% reported being humiliated in front of others at work, 28% reported being watched more closely than other workers, and 47% reported having to work twice as hard as others for the same treatment. For each type of unfair treatment, we observed a monotonic relationship with occupational injury wherein increasing frequency of exposure was associated with increased odds of injury. We also observed monotonic relationships between total load and high-frequency exposure to unfair treatment and odds of injury. Work-related unfair treatment is associated with injury among hospital workers. Programs and policies that focus on preventing unfair treatment may lessen injury burden in hospital workers.

Mandated rest breaks and occupational injuries and illnesses in Dallas County, TX construction workers: A quasi-experimental, comparative interrupted time series study.

We estimated associations of a rest break ordinance, implemented for construction workers in Dallas, Texas in 2016, with workplace injuries and illnesses. We used workers' compensation claims data to compare changes in rates of injuries and illnesses among Dallas, TX County construction (i.e., "treated") workers with changes in untreated workers, before (2013 - 2015) and after (2016 - 2018) a rest break ordinance was implemented. Immediately after the ordinance was implemented, rates of injuries/illnesses among treated workers were modestly lower than in comparison workers (Rate Ratio comparing post- versus pre-mandate rates, treated versus comparison workers: 0.89, 95% CI: 0.72 - 1.11). Post- vs pre-ordinance slope trends were similar in the treated versus the comparison group. Ten-minute rest breaks were associated with modestly lower rates of workplace injury/illnesses. More comprehensive standards may be needed for protection.

Did safety-engineered device implementation contribute to reducing the risk of needlestick and sharps injuries? Retrospective investigation of 20 years of observation in a Specialist Tertiary Referral Hospital.

In Poland, there are numerous cases of injuries caused by sharp instruments annually, still significantly more than in other European Union countries. The aim of this study was to analyze work-related injuries among healthcare workers in a selected hospital before and after the implementation of safety-engineered devices (SED). Retrospective analysis of medical documentation regarding occupational needlestick and sharps injuries (NSSI) in a tertiary referral surgical hospital in 1998-2018. The study group consisted of nurses and doctors who had been injured and reported the incident. The frequency of injury reports, injury rate, and characterization of circumstances surrounding NSSI are presented. Over the period of 20 years, a total of 257 NSSI incidents were reported. The average injury rate was statistically significant for nurses (p = 0.004) and was higher before the introduction of SED. Moreover, the number of injuries among nurses showed a downward trend during the study period. However, for doctors, there was no statistically significant difference in the median puncture rate (p = 0.099), and the number of injuries showed an increasing trend. In this study, the authors' have demonstrated not only the occurrence of injuries and punctures in the daily work of medical personnel but also the potential for their reduction through the use of safety equipment at every workstation where healthcare services are provided using sharp medical instruments. Int J Occup Med Environ Health. 2024;37(2).

Frequent Sural Nerve Injury with Posterior Approach for Ankle Fracture Fixation

Introduction: The purpose of this study was to report the incidence of iatrogenic sural nerve injury in a large, consecutive sample of surgically managed ankle fractures and to identify factors associated with sural nerve injury and subsequent recovery. We hypothesize that a direct posterior approach may be associated with higher risk of iatrogenic sural nerve injury. Methods: A retrospective cohort study of 265 skeletally mature patients who sustained ankle fractures over a 2-year period was done. All were treated with open reduction and internal fixation of fractured malleoli. Patient, injury, and treatment features were documented. The presence (n = 26, 9.8%) of sural nerve injury and recovery of sural nerve function were noted. Results: All 26 sural nerve injuries were iatrogenic, occurring postoperatively after open reduction and internal fixation. Patients who sustained sural nerve injuries had more ankle fractures secondary to motor vehicle collisions (23.1% versus 9.2%), more associated trimalleolar fractures (69.2% versus 33.9%), and more Orthopaedic Trauma Association/AO 44B3 fractures (57.7% versus 25.1%), all P &lt; 0.05. A posterior approach to the posterior malleolus through the prone position was used in 20.4% of patients. All 26 of the sural nerve injuries (100%) occurred when the patient was placed prone for a posterior approach, P &lt; 0.001. Therefore, 26 of the 54 patients (48%) treated with a posterior approach sustained an iatrogenic sural nerve injury. 62% of patients had full recovery of sural nerve function with no residual numbness, and patients with nerve recovery had fewer associated fracture-dislocations (23.1% versus 100%, P = 0.003). Conclusions: A posterior approach for posterior malleolus fixation was associated with a 48% iatrogenic sural nerve injury rate, with 62% recovering full function within 6 months of injury. Morbidity of this approach should be considered, and surgeons should be cautious with nerve handling. Level of Evidence: Level III, Therapeutic.

The Role of Sports Medicine in Preventing and Managing Common Injuries in Athletes

Many international athletic organizations have proposed injury-reduction strategies. These practices include injury screening, emergency medical care, along with injury management measures prior to return-to-play. The extent to which these methods are being adopted in a developing nation like Iraq is uncertain. This paper was contributed to study the role of sports medicine in preventing and managing common injuries in athletes. Our paper focused on the role of sports medicine in treating injured athletes in Iraq. To build up, our methodology’s study was enrolled rate of acute injuries for 80 cases based on organized the demographic characteristics of sports players with three basics which are football, athletics, and handball. The data were analysed using the SPSS program. This study was presented a cumulative analysed and covered all 80 cases during period from 17th January 2022 to 19th March 2023.mThe findings demonstrated a lack of pre-season screening and return-to-play preparedness for all injured athletes. Furthermore, for the majority of injury categories, best practice standards were not followed. This study identified constraints, including sports resource providers' inadequate knowledge, insufficient and insufficiently specialized facilities for treating injured athletes, and policies mandating treatment for injured athletes. These obstacles hinder the implementation of best medical practices.

Comparing the healthy development of youth Australian Rules Footballers across talent development and community settings

ObjectivesThis study aimed to compare talent development athletes to community-level athletes in Australian Rules Football across various markers of healthy youth development.MethodsSurvey data were collected from 363 youth athletes (126...

Safety assessment of using macintosh laryngoscope, airtraq, I-view, UESCOPE by non-clinically experienced individuals on a manikin model: A randomized cross-over study

BackgroundEndotracheal intubation is the best way of restoring airway patency. Covid-19 epidemic showed that the health professionals without previous experience may be forced to use this technique in the state of necessity, exposing the patients to both local and systemic complications. In our study we wanted to specify which of the four laryngoscopes is safer for a patient when used by this group of medical staff. MethodsThe study involved 55 4th year students of Faculty of Medicine and Dentistry who had never previously practiced using videolaryngoscopes and had minimal experience with the Macintosh laryngoscope. ResultsDental injury rates: Macintosh (n = 18, 33 %), I-View (n = 13, 24 %), UESCOPE (n = 10, 18 %), and Airtraq (n = 7, 13 %), though differences were not statistically significant (p = 0.071). Notable variations were observed in maximum pressure: I-View (88.9 mmHg, IQR: 72.75–106.5), Macintosh (87.1 mmHg, IQR: 75.1–110.35), UESCOPE (72.7 mmHg, IQR: 61–86), and Airtraq (54.7 mmHg, IQR: 41.8–67.25). The difference between Macintosh and I-View was not significant. Pressure during intubation showed a similar trend: Macintosh (48.3 mmHg, IQR: 42.85–59.4), I-View (45.2 mmHg, IQR: 35.7–54.85), UESCOPE (33 mmHg, IQR: 27.95–41.5), Airtraq (21.6 mmHg, IQR: 18.4–24.9). Airtraq usage correlated with shorter intubation times (9.9 s, IQR: 8.4–12.25) compared to Macintosh (27 s, IQR: 23.8–32.05), I-View (24.5 s, IQR: 19.25–31.35), and UESCOPE (23.6 s, IQR: 17–29.5). Airtraq was the best-rated device by respondents. Airway visualization was superior with Airtraq, as assessed by Cormack-Lehane and POGO scales. On the Cormack-Lehane scale, Airtraq scored 2 (IQR: 2-2), versus Macintosh (3, IQR: 3-3), I-View (2, IQR: 2–3), and UESCOPE (2, IQR: 2–3). On the POGO scale, Airtraq scored 70 % (IQR: 60%–90 %), compared to Macintosh (30 %, IQR: 20%–30 %), I-View (60 %, IQR: 30%–60 %), and UESCOPE (50 %, IQR: 30%–70 %) ConclusionsAirtraq laryngoscope on a mannequin model turned out to be device that damages the teeth the least, exerts the lowest pressure on the tongue and giving the possibility of the fastest intubation with the greatest comfort for the operator in the studied group of users.

Investigation on the Alleviating Effect of Standardized Three-Step Nursing on Perioperative Pressure Injury in Patients with Spinal Fracture Accompanied by Spinal Cord Injury

Objective: To explore the alleviating effect of standardized three-step nursing on perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury. Methods: A retrospective analysis was conducted on the clinical data of 153 patients who underwent surgical treatment for spinal fracture accompanied by spinal cord injury in our hospital from January 2021 to January 2024. All patients met the criteria for inclusion and exclusion. According to the nursing interventions received during the perioperative period, the patients were divided into a control group (n = 76) and an observation group (n = 77). The control group received routine nursing interventions during the perioperative period, while the observation group received standardized three-step nursing interventions. The occurrence, severity, area, and pain [Visual Analog Scale (VAS)], coagulation indicators [Prothrombin Time (PT), Fibrinogen (FIB), D-dimer (D-D)], activities of daily living [Barthel Index], and quality of life [General Quality of Life Inventory (GQOLI-74)] were compared between the two groups. Results: ① Occurrence and severity of perioperative pressure injury: In the control group, 18 cases of pressure injury occurred, including 5 cases of stage I, 11 cases of stage II, and 2 cases of stage III; In the observation group, 7 cases of pressure injury occurred, including 4 cases of stage I and 3 cases of stage II. The occurrence rate and severity of pressure injury in the observation group were lower than those in the control group (P < 0.05). ② Area of injury and pain: The area of injury on the day of surgery and 5 days after surgery in the observation group was lower than that in the control group (P < 0.05); The VAS score 5 days after surgery in the observation group was lower than that in the control group (P < 0.05). ③ Coagulation indicators: 5 days after surgery, the levels of D-D and FIB in the observation group were lower than those in the control group, while PT was higher than that in the control group (P < 0.05). ④ Activities of daily living and quality of life: 3 months after surgery, the Barthel score and GQOLI-74 score in the observation group were higher than those in the control group (P < 0.05). Conclusion: Standardized three-step nursing can significantly reduce the occurrence rate, severity, and area of perioperative pressure injury in patients with spinal fracture accompanied by spinal cord injury, alleviate patient pain, improve coagulation function, and enhance levels of activities of daily living and quality of life.

Early sport specialization impact on rates of injury in collegiate and professional sport participation: A systematic review and meta-analysis

Early sport specialization (ESS) is prevalent among adolescent athletes aspiring for elite status. However, the impact of ESS on sports injury (SI) rates during their collegiate and professional careers remains unclear. This systematic review and meta-analysis evaluate the effect of ESS on SI rates during high-level sport participation. Data sources Search included PubMed, Web of Science, SPORTDiscus, EMBASE, Cochrane, CINAHL, ERIC, and Medline. Study selection PRISMA guidelines were followed to identify peer-reviewed articles published until 01 August 2023. Eligible studies reported numbers of athletes in collegiate and professional teams, including national, in ESS and their counterpart category, along with the portion with at least one SI. Studies on concussion or non-contact injuries, or without explicit injury reports during elite sport participation were excluded. Of 526 studies, 13 met the criteria, and 5 were included in the quantitative analysis. These studies reported SIs on collegiate and professional athletes. A total of 3087 athletes were analyzed (ESS = 45%). The overall effect showed that ESS athletes had a lower odds ratio (OR = 0.7) of a SI during high-level sport participation, but this finding was not statistically significant (p &gt; 0.05). Results demonstrated that ESS athletes had a lower odds ratio (OR = 0.7) of a SI during elite sport participation, but the effect was not statistically significant. Articles with clear reports are scarce, and thus limit the impact of the findings in this study. High heterogeneity was evident in this analysis, largely due to lack of standardized terminology, evaluation, and data representation. Prospective studies that consider diverse athlete population of the same sport are warranted.

Anticoagulant prophylaxis in patients with liver disease and atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults worldwide. The use of oral anticoagulants (DOACs) is an effective way to prevent ischemic stroke in patients with AF, reducing the risk of stroke by approximately 64 %. In patients with liver cirrhosis (LC), the presence of AF is associated with higher rates of in-hospital mortality, stroke and acute kidney injury compared with patients without arrhythmia. Liver disease and especially cirrhosis are associated with an increased risk of not only thrombosis but also bleeding, making the decision about anticoagulant therapy in these patients very difficult. The article reviews the current literature regarding the use of modern DOACs and traditional antithrombotic agents, such as vitamin K antagonists and heparins, in patients with cirrhosis and AF.

Epidemiology of neuromuscular injuries in guitar players living in Portugal: Associated risk factors.

Playing guitar involves several physical demands, most inclusive of which are long hours of practice, which can make musculoskeletal symptoms common. To determine the epidemiology of neuromuscular injuries in guitar players residing in Portugal and risk factors. The sample consisted of 105 guitar players, being 103 (98.10%) men, aged between 30-75 years (29,83±10,23). The measurement instrument used was a digital survey, shared by email, on social networks and in person. Fifty-six (53.30%) guitar players had injuries throughout their musical practice, totaling 132 injuries, 13 (12.40%) guitar players were injured at the time of assessment and 31 (29.5%) guitar players had injuries in the last 12 months, totaling 63 injuries. The value of injury proportion was 0.29 (CI 95% : 0.14-0.44) and the injury rate was 0.42 injuries per 1,000 hours of music practice. The most common types of injury were: tendinopathy (22; 34.92%) and low back pain (9; 14.29%). The most affected anatomical sites were: wrist (18; 28.57%) and lumbar spine (10; 15.87%). Repetitive movement was the injury mechanism most mentioned by guitar players (24; 35.29%) followed by maintaining postures for a prolonged period of time (15; 22.06%). Guitar players who did not warm up before practicing were 0.33 (CI: 0.13-0.79; p = 0.013) more likely to have an injury. There was a high percentage of injuries in guitar players and failure to warm up was a risk factor for the development of injuries. This type of study can help in creating injury prevention strategies in this type of population.

The Effects of Boxing Glove Design on Thumb Position When Making a Fist for Striking.

Peveler, WW, Schoffstall, J, Coots, J, Kilian, J, and Glauser, J. The effects of boxing glove design on thumb position when making a fist for striking. J Strength Cond Res 38(5): 948-950, 2024-It has been suggested that boxing glove design alters thumb position increasing the risk of injury. The purpose of this study was to determine the effects of boxing glove design on thumb joint angles when making a fist. Ten experienced fighters participated in this study. A DEXA scan was used to produce an x-ray image of thumb position for all conditions (no gloves and 10-oz boxing gloves). Mean values for dependent measures were compared using a paired-sample T test and an alpha of 0.05. The carpometacarpal (CMC) joint angle was significantly different between no glove (14.1 ± 6.54°) and boxing glove (34.2 ± 7.60°) at p ≤ 0.001. The metacarpophalangeal (MP) joint angle was significantly different between no glove (132.6 ± 12.74°) and boxing glove (149.40 ± 8.15°) at p ≤ 0.001. The IP joint angle was not significantly different between no glove (135.50 ± 19.12°) and boxing glove (144.40 ± 17.39°) at p = 0.269. The perpendicular distance from the second metacarpal of the hand to the center of the MP joint was significantly different between no glove (0.48 ± 0.54 cm) and boxing glove (1.84 ± 0.29 cm) at p ≤ 0.001. Use of a boxing glove resulted in abduction of the thumb away from the hand and increased CMC and MP joint angles that were significantly different in relation to making a fist without a glove. Information from this study may provide insight into the high rate of thumb injury and provide insight for future boxing glove design.

Shots fired: evaluation of vascular injury, compartment syndrome, and transfusion rates among civilian ballistic orthopaedic fracture patients presenting to two Level I trauma centres.

This study investigates baseline patient demographics and predictors of vascular injury, blood transfusion, and compartment syndrome in patients with orthopaedic fractures secondary to GSWs at two high-volume Level I trauma centres. A retrospective chart review of all GSW-related trauma patients at two Level I trauma centres between July 2019 and September 2021 was conducted. Chi-squared and two-tailed independent t tests were used for data analysis, and logistic regression with odds ratios (OR) determined predictors of primary outcomes. Among 478 GSW patients, 94 (19.7%) sustained 130 orthopaedic fractures, most commonly at the lower extremity (77.7%). Orthopaedic fracture patients showed significantly higher rates of vascular injury (29.8 vs. 4.7%, p < 0.001), transfusion (27.7 vs. 12.8%, p = 0.006), and compartment syndrome (3.2 vs. 0.3%, p = 0.011) compared to non-orthopaedic injury patients. Univariable analysis identified ankle (OR = 47.50, p < 0.001) and hip/femur fractures (OR = 5.31, p < 0.001) as predictors of vascular injury. Multivariable logistic regression revealed lower extremity vascular injury (OR = 54.69, p = 0.006) and anatomic fracture sites of the humerus (OR = 15.17, p = 0.008), clavicle/scapula (OR = 11.30, p = 0.009), and acetabulum/pelvis (OR = 7.17, p = 0.025) as predictors of blood transfusion. Univariable analysis showed lower extremity vascular injury (OR = 30.14, p = 0.007) as a predictor of compartment syndrome. These findings underscore the importance of diagnosing and managing vascular injuries and compartment syndrome in GSW-related orthopaedic fractures, emphasizing the necessity for targeted transfusion strategies in such cases.

[Diagnosis and treatment of 68 cases of traumatic facial nerve paralysis].

Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases（38 ears）, and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases（52 ears） , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases（50 ears） were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases（24 ears） of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved（P<0.05）, and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment（P<0.05）. There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes（P>0.05）. The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse（P<0.05）, but there was no significant difference between the facial nerve function after treatment（P>0.05）. There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group（P>0.05）. Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.

Multi-institutional review of characteristics and management of gunshot wounds to the spine

Background ContextGunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data. PurposeTo characterize the management and follow-up of GSWs to the spine. Study Design/SettingA multi-institutional retrospective review of the experience of two urban Level 1 trauma centers. Patient SamplePatients with GSWs to the spine between 2010-2021. Outcome MeasuresMeasures included work status, follow-up healthcare utilization, and pain management were collected. MethodsCharts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY). Results271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<0.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<0.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score. ConclusionsGiven the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population.