Major Cause Of Trauma Research Articles

Characteristics of Traumatic Globe Rupture after Keratoplasty

To analyze risk factors of traumatic wound rupture after penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). Retrospective case series. A total of 1962 consecutive cases were included. A review of consecutive patients undergoing either PKP (1776 eyes) or DALK (186 eyes) at 1 regional center between 1998 and 2006 was carried out to determine the incidence of traumatic globe rupture after keratoplasty. Ophthalmic and demographic factors were analyzed. A comparison with previous literature was performed. Incidence, causes, and final visual acuity. Of 43 eyes with globe rupture during this period, 36 received keratoplasty during this study period. The incidence of globe rupture after keratoplasty was 1.8% (36/1962). These 36 cases consisted of 35 of the 1776 eyes receiving PKP (2.0%) and 1 of the 186 eyes receiving DALK (0.5%). Globe rupture occurred 61.6+/-50.0 months (mean +/- standard deviation) after keratoplasty in 43 cases. The major cause of trauma was a fall in elderly patients (73.2+/-8.4 years, 17 eyes), with lens damage occurring in all such cases. Although 15 eyes (34.9%) had a visual acuity of 20/200 or better at final follow-up, eyes showing lens damage were associated with poorer visual acuity than eyes with no lens damage (P<0.01). Wound weakness persisted for a long period after keratoplasty. A fall was observed frequently in elderly patients and resulted in poor visual outcome. Globe rupture associated with lens injury could be the predictor for future visual outcome.

Patterns of injury sustained by car occupants with relation to the direction of impact with motor vehicle trauma — evidence based review

Motor vehicle collisions (MVCs) have been reported as the leading cause of major trauma and subsequent morbidity and mortality, for people under 20 and those between 20 and 64 years of age. Crash fatalities have significantly reduced in number since the introduction of appropriate seat belt restraints and air bags for drivers and front seat passengers. Other factors which have positively influenced the outcome of MVCs include information from pre-hospital personnel at the crash scene, regarding the vehicle's exterior and interior damage, in addition to the direction of impact. The patterns of injury sustained by car occupants during a collision depend upon the direction of impact. We provide an up to date review of the key literature regarding injury patterns sustained to occupants of light passenger vehicles (passenger cars, vans, utility vehicles and pickup trucks) in correlation with the direction of impact. We strongly believe that this knowledge can allow pre-hospital personnel and clinicians in the emergency department to gain foresight when suspecting and identifying the injuries sustained by car occupants during a motor vehicle collision.

Splenic injuries in children: The challenges of non operative management in a developing country

Aim: This is to report the challenges and experience gained with non operative management of splenic injuries in a developing country where sophisticated imaging facilities are either not available or exorbitantly expensive. Materials and Methods: All patients who presented with splenic injury at the University of Benin Teaching Hospital between January, 2000 and December, 2006 were assessed and those who met the criteria were recruited for non operative management. Diagnosis of splenic injury was made by combining clinical assessment and ultrasound findings. Results: A total of 24 children with a mean age 12 ± 0.04 years and male/female ratio 1.7:1 were treated during the period. Road traffic accident, accounting for 50% of the cases was the major cause of trauma followed by falls from heights. Delay in presentation was a major concern as 62.5% of them were not referred until shock supervened. None of the patients could afford CT scan but ultrasound scan was able to confirm diagnosis in all. Basing decision on clinical parameters, non operative management was successfully done in 75% while 25% were operated as they could not meet the criteria. No mortality was recorded in the non operated group while one was recorded in those operated. The average length of hospitalization was two weeks. Conclusion: Non operative management of splenic injuries can be successfully done in a developing country using clinical parameters as a guide. The 75% of patients with splenic injury treated can be improved upon by health awareness campaign/improvement in government policy that will result in early presentation.

Ocular Trauma in a Rural Population of Southern India: The Andhra Pradesh Eye Disease Study

To determine the prevalence of ocular trauma and proportion of blindness and visual impairment due to ocular trauma in a rural population of southern India.Population-based cross-sectional epidemiological study.A total of 7771 subjects of all ages, representative of the rural population of Andhra Pradesh.The subjects underwent a detailed interview and comprehensive ocular evaluation as part of the population-based Andhra Pradesh Eye Disease Study.An eye was considered to be blind due to trauma if best-corrected distance visual acuity was worse than 6/60 and the cause was attributed to ocular trauma.A total of 824 (10.6%) subjects gave a history of ocular trauma in either eye, including 76 (1.0%) persons reporting trauma in both eyes. The overall age- and gender-adjusted prevalence of history of eye injury in this rural population was 7.5% (95% confidence interval [CI], 7.0%-8.1%). Men were more likely to have an eye injury than women (odds ratio [OR], 2.1 [95% CI, 1.8-2.5]). After adjusting for gender and other demographic factors, ocular trauma was significantly more frequent among laborers (OR, 1.5 [95% CI, 1.2-1.7]) when compared with other occupational groups. After adjusting for gender, injury with vegetable matter such as a thorn, branch of a tree, plant secretion, etc. (n = 373 [45.3%]) was the major cause of trauma reported in this population. The majority of the eye injuries occurred at the workplace (n = 461 [55.9%]), followed by home (n = 179 [21.7%]). The majority of those affected (n = 806 [97.8%]) did not wear any eye protection at the time of trauma. A significant proportion (n = 307 [43.1%]) of subjects who sought treatment for an eye injury went to an ophthalmologist. Trauma was responsible for unilateral blindness in 39 subjects, an age- and gender-adjusted prevalence of 0.6% (95% CI, 0.4%-0.8%).Most ocular injuries in this rural population occurred at the workplace, suggesting the need to explore workplace strategies to minimize ocular trauma as a priority. Eye care programs targeting high-risk ocular trauma groups may need to consider ocular trauma as a priority in eye health awareness strategies to reduce blindness due to trauma.

A population-based assessment of major trauma in a large Canadian region

Background The cause of major trauma has not been well defined using population-based methodologies. Methods We performed a population-based surveillance of major traumatic injuries in adult residents of the Calgary Health Region over a period of 3 years. Results A total of 1,475 victims of major trauma were identified (69.5 per 100,000/y). Males were at significantly higher risk as compared with females (104.5 vs. 35.2 per 100,000; relative risk = 3.0, 95% confidence interval = 2.64–3.35), as were urban as compared with rural residents (70.7 vs. 49.0 per 100,000; relative risk = 1.4; 95% confidence interval = 1.11–1.91). A strikingly high incidence rate of major trauma was observed among those aged 85 years or more at 242.3 per 100,000 per year; elderly men were at 16.8-fold (95% confidence interval = 11.04–24.79) higher risk than young females. The majority were unintentional (53.9 per 100,000/y). Suicide, assault, and homicide occurred at annualized rates of 8.5, 4.8, and 1.6 per 100,000, respectively. Motor vehicle-related injuries (39%), falls or jumps (33%), and being struck by an object or animal (10%) were responsible for the majority of traumas. Firearm injuries were relatively uncommon (2.0 per 100,000/y). The annual mortality rate was 20.0 per 100,000. Conclusions This study provides rigorous, population-based data on the cause of severe injury in the Calgary Health Region. It is hoped that ongoing work in this area will be useful in the development of effective injury prevention and health resource allocation strategies.

Facial fractures: a 1-year retrospective study in a hospital in Belo Horizonte

A retrospective study was performed to assess facial fractures in patients treated at a public hospital in Belo Horizonte, in 2000. The data collected included age, gender, etiology, distribution of maxillofacial trauma considering day of the week and month, anatomic site of the fracture, and treatment. The analyses involved descriptive statistics and chi-squared test, Bonferroni test and analysis of variance. A total of 1,326 facial fractures were found in 911 patients. Most fractures occurred in adults with age ranging from 21 to 30 years. Men were more affected than women, with a male-female ratio of 4.69:1. Accidents causing facial fractures occurred predominantly on weekends. Bicycle and motorcycle accidents were the major cause of trauma, followed by interpersonal violence, automobile accidents, and falls. When the relation between the gender and the etiology of facial fractures was analyzed, a significant relation was noted between these variables (p < 0.001). There was also a relation between the patients' age and the site of the fractures (p = 0.0014). The mandible was found to be the most commonly fractured bone in the facial skeleton, followed by the zygomatic complex and the nose. A non-surgical approach was chosen in most cases. There were significant differences between the kind of treatment applied and the site of the fracture (p < 0.001).

Clinical Assessment of the Patient with Major Injuries

Multiple injury is the most common cause of death among young adults in the UK, and causes significant morbidity in survivors, frequently requiring prolonged and expensive multidisciplinary care. Road traffic accidents are the most common cause of major trauma. In year 2000, there were 2800 deaths from road accidents on the roads of the UK. The most common traumatic injuries in the UK are blunt injuries (see Vidyasankar et al, page 185), often caused by road traffic accidents, falls or assault. Penetrating trauma is rare, but is becoming less so. The patient with multiple injuries must receive swift, coordinated and highly skilled care in the Accident and Emergency (A & E) resuscitation room. This demands a structured and rehearsed approach by the trauma team. The ‘gold standard’ of UK trauma care is embodied in the principles of the Advanced Trauma Life Support® (ATLS®) programme, designed by the American College of Surgeons. The ATLS® methodology was designed to enable all carers of a critically injured patient to be able to work to a common plan, with definitive objectives for all members of the team. The principles are that immediately life-threatening injuries are patient's condition has been stabilized. This contribution outlines the steps that need to be taken to achieve this.

Major injury associated with all-terrain vehicle use in Nova Scotia: a 5-year review

Riding all-terrain vehicles (ATVs) is a popular recreational activity, with approximately 1.5 million users in Canada. Despite legislation aimed at reducing injury rates, ATV-related incidents remain a major cause of trauma and death. This paper reviews the epidemiology of major injury associated with ATV use in Nova Scotia. The Nova Scotia Trauma Registry was used to identify all adults over age 15 who sustained major ATV-related trauma (Injury Severity Score [ISS] >/=12) within a 5-year period. Demographic variables, temporal statistics, alcohol use, helmet use, injury characteristics and injury outcome variables, including ISS, length of stay (LOS), Glasgow Coma Scale score and discharge status were evaluated. Twenty-five patients met the inclusion criteria. Most (92%) were males, and 64% were between 16 and 34 years of age. Most injuries occurred between 1300 hrs and 1900 hrs, 52% occurred on the weekend, and 40% occurred in the spring. The average ISS was 22.1, and injuries to the central nervous system comprised 39% of all major injuries. Alcohol was involved in up to 56% of all incidents, and only 4 patients (16%) were known to be wearing a helmet at the time of injury. Average hospital LOS was 21.6 days. ATV-related incidents are a continuing source of major injury. This paper describes the epidemiology of ATV-related major trauma presenting to the sole tertiary care referral centre in one province. Information gained from this study should be used to influence ATV public education programs.

THE INJURED EYE

Approximately 2 million eye injuries occur in the United States annually. Eye trauma is the fourth most common cause of visual loss in people under the age of 45 and the leading cause of noncongenital blindness in patients under 20 years of age.40, 43, 54 Eye trauma, with its very real threat of loss of vision, can be psychologically devastating. The sudden nature of trauma does not allow the patient time to adjust to the reality and consequences of the injury. The types of eye trauma that may require surgical repair include blunt trauma, perforating injury, foreign body injury (including gunshot wounds), thermal injury, animal bites, self-inflicted wounds, and child abuse. Sports injuries are a major cause of trauma to the eye; each year 40,000 sports-related eye injuries are treated in hospital emergency rooms. In the United States, racquet sports cause almost one third of all sports-related eye injuries to athletes between the ages of 25 and 65. Baseball is the most common cause of eye injury in children between the ages of 5 and 15 years.43, 54 The nature of ophthalmologic surgery is not life-threatening; therefore, the mortality associated with anesthesia should be low and reflect the patient's physical status. The challenge to the anesthesiologist is twofold: to care for the patient with an eye injury in the setting of multisystem trauma and to preserve vision by favorably manipulating anatomic and physiologic variables as they relate to the eye (Fig. 1). During surgery, proper anesthetic management can control intraocular pressure (IOP), provide optimal operating conditions, and contribute to a successful surgical outcome.

An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985)

A retrospective study was undertaken to assess mandibular fractures presenting over the period 1977–1985 in Dundee, Scotland. The data collected included age, sex, aetiology, month in which injury occurred, anatomical site of fracture, associated maxillofacial trauma and treatment modalities. The majority of fractures were sustained by males in the age group 20 to 29 years. Assault was the major cause of trauma followed by falls and road traffic accidents. The posterior body region was found to be the most common fracture site in the mandible. The level of such trauma has more than doubled, since a similar study was undertaken between the years 1961 to 1970.

しつじん帯損傷からみた大たいけい骨関節周辺のはく離骨折

Group I consisting of 53 knees (60 cases) of avulsion fracture of the femorotibial joint treated in the last 9 years was compared Group II consisting of 65 knees of intraligamentous rupture treated in the last 3 years. Average age at the time of Group I was 30 years which was slightly higher than that of Group II whose average age was 26 years. Injury of combined ligaments was 34.0% for Group I and 18.5% for Group II. Cartilage injury was 22.6% for Group I and 40.0% for Group II. Especially many lateral meniscus injuryies in Group I and medial injuries in Group II were observed. Major causes of trauma in Group I were traffic accidents and of Group II were sport injuries. Our conclusion was that avulsion fracture of this joint was caused by high rates of loading combined with sheer force rather than low rates of loading (sprain).