Neck Fractures Research Articles

Role of Biplane Double-Supported Screw Fixation (BDSF) in Management of Fracture Neck Femur and Its Comparison with Conventional CC Screw Fixation.

The aim of this study is to evaluate comparative biomechanical fixation provided with the BDSF method with the conventional CC screw fixation for treatment of femoral neck fractures with three parallel cannulated screws. This is a prospective cohort study. There were two teams of surgeons out of which one team operated the patients with BDSF technique and second with conventional CC screw fixation technique; thus, the patients were randomly distributed into two groups. Patients were included in the study as per the following inclusion and exclusion criteria. Union was achieved in 15 (83.33%) patients managed by conventional CC screw technique, while union was achieved in 11 (91.67%) patients managed by BDSF technique in the present study. The average Harris hip score in present study was 90 score in patients managed by BDSF technique, while the average Harris hip score in present study was 80 score in patients managed by BDSF technique. Both BDSF and conventional CC screw fixation are good fixation methods for fracture neck of femur. But functional outcome and fracture union rates are better with BDSF Technique. Although, there are some minor problems noted in BDSF technique such as outer cortical fracture at the entry point of beam screw and opening up of anterior cortex of oblique fracture patterns. Thus, BDSF method provides reliable fixation in which early mobilization and partial weight bearing of the patient may be allowed.

A comparative study of the outcome of displaced fractures neck of femur treated with unipolar prosthesis and fenestrated bipolar prosthesis in active elderly patients

Background: Fractures of the neck or femur are among the most serious surgical problems affecting older groups. These fractures constitute a large burden on families and society due to the inability to stand and walk. Objectives were to compare the functional outcomes of unipolar (Austin-Moore) versus uncemented bipolar hemiarthroplasty in displaced fractures neck femur among these active elderly patients. Methods: This prospective interventional study was carried out at NITOR, Dhaka, Bangladesh in total 60 patients. Among them, 30 patients were treated with unipolar and 30 patients were treated with fenestrated bipolar prosthesis through a lateral approach. Results: There was no significant age difference between the two groups. Regarding the functional outcome, 6 (20%) patients in the unipolar group and 11 (36.67%) patients in the bipolar group had excellent outcomes. About the same number of patients had good outcomes 36.67% in the unipolar and 43.33% in the bipolar group; the fair and poor outcome was more in the unipolar group than the bipolar group. So, the final outcome after 6 months of operation, 57.57% of patients had satisfactory results in the unipolar group whereas 80% of patients had satisfactory results in the bipolar group. The average Harris hip score was 77.14±14.58 in the unipolar group and 84.63±10.15 in the bipolar group and the p=0.01 which is below 0.05. So, the result is statistically significant. Conclusions: Uncemented bipolar hemiarthroplasty with a fenestrated stem can give better functional outcomes for displaced intracapsular femoral neck fractures in active elderly patients compared to Austin-Moore prostheses.

Late-Presenting Septic Arthritis of the Hip in Children: Variations in Presentation and a Review of 25 Hips After Surgical Debridement.

The septic arthritis of the hip (SAH) is one of the most common musculoskeletal infections occurring in pediatric populations requiring urgent intervention. This study discusses the myriad of clinical and radiological presentations of late-presenting SAH in children and the outcomes of surgical management. After ethical approval, we did retrospective reviews of children treated for late-presenting SAH (afterfive days of symptoms). We excluded late cases with established sequelae. We recorded age, duration of symptoms, clinical evaluation, and radiographs. We evaluated the final results clinically and radiologically. Twenty-four patients with 25 hips were eligible for evaluation. At presentation, all had decreased or painful hip movements, but none had a fever. Radiographs revealed the following changes: hip dislocation (four), capital femoral slip (seven), proximal femur/neck osteomyelitis (six), pathological fractured neck femur (two), iliac osteomyelitis (two), and early arthritic changes (two). Hip arthrotomy was done in all cases. Frank pus was found in 21 (84%) cases. Cases with capital slip and fractured neck femur required fixation with two smooth K-wires. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in three patients and tuberculosis in two cases. Clinical outcomes showed 14 patients with poor outcomes, eight with fair, and two with good. Avascular necrosis (AVN) of the femoral head was noted in 14 hips and complete femoral head resorption in nine. The late-presenting SAH in children has a myriad of presentations including dislocation and capital slip with unsatisfactory outcome. However, ongoing local infective processes may necessitate debridement. With limited salvage options available at the sequelae stage, awareness and training for early diagnosis and treatment may be the best way to improve the scenario. We recommend future multicenter randomized studies of predictive factors and indications of arthrotomy in late presenters.

Preoperative Templating for Total Hip Arthroplasty: A Method for Calibrating Digital Radiographs Using Patient Demographics and Anthropometric Measurements.

Background Preoperative templating aids the surgeon in estimating implant size and placement. Calibration markers are used to set the correct magnification of digital images before templating. Improper marker placement or complete absence can lead to inaccuracy or an inability to calibrate images altogether. Aims This study describes a method for calibrating images using a patient's femoral head size (FHS) predicted using demographics and anthropometric data. Materials and methods A formula predicting the FHS was derived from a cohort of 507 patients who underwent hemiarthroplasty for an intracapsular fractured neck of the femur through multivariate regression analysis. A separate validation cohort (n=50) who had undergone total hip arthroplasty (THA) had postoperative radiographs calibrated using the predicted FHS and the native contralateral hip as a surrogate calibration marker. The THA femoral head implant size was subsequently measured and compared with the actual implant size selected intraoperatively. Measurements were performed by two independent assessors to determine intra- and interobserver reliability. Results Multivariate regression analyses showed four variables significantly correlated with the size of the femoral head: gender (p < 0.001), height (p < 0.001), weight (p < 0.001), and race (Asian) (p = 0.01). Using these, a regression model to predict the FHS was obtained with an R2 value of 0.65 and a standard error of 2.18 mm. The validation cohort showed that THA head implant size could be accurately measured with an average root-mean-squared error (RMSE) of 1.41 mm (SD = 0.97 mm; %RMSE = 4.7%). The implant head size was measured to be within 5%, 10%, and 15% RMSE in 57.5%, 93.0%, and 100.0% of cases, respectively. There was excellent intraobserver (R2= 0.94 and 0.95) and interobserver (R2= 0.94) reliability. Conclusions The novel method proposed and validated in this study, using a predicted FHS to calibrate digital images, provides an alternative means of templating THA for fractured neck of the femur patients, in whom external calibration markers are often absent.

Retrospective analysis of 10 cases with esophageal fistula after anterior surgery for cervical spine fracture

ObjectiveThis study aims to discuss the appropriate treatment of esophageal fistula following anterior surgery for cervical spine fracture. MethodsClinical data of patients with cervical spine fracture treated at our research center from January 2000 to December 2019 were screened. Data of patients with esophageal fistula were included, and the causes of injury, diagnosis, and treatment were retrospectively analyzed. ResultsA total of 3578 patients with cervical spine fracture were screened, among whom there were 10 cases (0.28 %) of esophageal fistula. 60 % of the cases were early-onset and all were caused by intraoperative electric knife injury. The positive rate of early endoscopy was only 25 %, while routine radiography showed a positive rate of 33.3 % after three attempts. Among the six patients with early-onset esophageal fistula, three underwent sternocleidomastoid flap transfer and two underwent primary suture, all achieving successful healing. In the four cases of late-onset esophageal fistula, two patients received implant removal, debridement, incision lavage, and sternocleidomastoid muscle flap transfer three weeks later. One patient received implant removal, debridement, vacuum sealing drainage, followed by sternocleidomastoid muscle pedicle transfer muscle flap plus lavage two weeks later and achieved complete recovery. All patients gargled alternately with metronidazole and chlorhexidine gargle after surgery. ConclusionThe occurrence of esophageal fistula is associated with surgical procedures, esophageal injury, and implant compression. Esophagography and endoscopy are the primary diagnostic methods, while incision exploration after ingestion of food mixed with methylene serves as a supplementary approach. Recommended treatments include alternating metronidazole and chlorhexidine gargles, esophageal rest, repair of the fistula, muscle flap packing, lavage and drainage, nutritional support, and removal of internal fixation if necessary. Post-surgery administration of antibiotics should continue until three consecutive lavage cultures yield negative results.

Development of a Machine Learning-Based Model for Accurate Detection and Classification of Cervical Spine Fractures Using CT Imaging.

Cervical spine fractures represent a significant healthcare challenge, necessitating accurate detection for appropriate management and improved patient outcomes. This study aims to develop a machine learning-based model utilizing a computed tomography (CT) image dataset to detect and classify cervical spine fractures. Leveraging a large dataset of 4,050 CT images obtained from the Radiological Society of North America (RSNA) Cervical Spine Fracture dataset, we evaluatethe potential of machine learning and deep learning algorithms in achieving accurate and reliable cervical spine fracture detection. The model demonstrates outstanding performance, achieving an average precision of 1 and 100% precision, recall, sensitivity, specificity, and accuracy values. These exceptional results highlight the potential of machine learning algorithms to enhance clinical decision-making and facilitate prompt treatment initiation for cervical spine fractures. However, further research and validation efforts are warranted to assess the model's generalizability across diverse populations and real-world clinical settings, ultimately contributing to improved patient outcomes in cervical spine fracture cases.

Development of a Predictive Model for Persistent Instability Following Conservative Management of Type II Odontoid Fractures

Odontoid fractures are common cervical spine fractures; however, significant controversy exists regarding their treatment. Risk factors for failure of conservative therapy have been identified, although no predictive risk score has been developed to aid in decision-making. A retrospective review was conducted of all patients evaluated at a level 1 trauma center. Patients identified with type II odontoid fractures as classified by the D'Alonzo Classification system who were treated with external orthosis were included in analysis. Patients were considered to have failed conservative therapy if they were offered surgical intervention. A machine learning method (Risk-SLIM) was then utilized to create a risk stratification score based on risk factors to identify patients at high risk for requiring surgical intervention due to persistent instability. A total of 138 patients were identified as presenting with type II odontoid fractures that were treated conservatively; 38 patients were offered surgery for persistent instability. The Odontoid Fracture Predictive Model (OFPM) was created using a machine learning algorithm with a 5-fold cross validation area under the curve of 0.7389 (95% CI: 0.671 to 0.808). Predictive factors were found to include fracture displacement, displacement greater than 5 mm, comminution at the fracture base, and history of smoking. The probability of persistent instability was <5% with a score of 0 and 88% with a score of5. The OFPM model is a unique, quick, and accurate tool to assist in clinical decision-making in patients with type II odontoid fractures. External validation is necessary to evaluate the validity of these findings.

Meta-Analysis of Total Hip Arthroplasty versus Hemiarthroplasty in Fracture Neck Femur

Meta-Analysis of Total Hip Arthroplasty versus Hemiarthroplasty in Fracture Neck Femur

MAGNITUDE OF FRACTURE NECK OF FEMUR IN PATIENTS WITH IPSILATERAL FRACTURE SHAFT OF FEMUR IN ADULT

Background: Magnitude of fracture neck of femur associated with ipsilateral fracture shaft of femur is rare and challenging in terms of diagnosis and management. Fracture neck of femur is associated with 0.8-9 % of ipsilateral fracture shaft of femur. Fracture neck of femur is often missed preoperatively with incidence ranging from 20-50%. This study was done with an objective of assessing the magnitude of fracture neck of femur in patients with ipsilateral fracture shaft of femur. Methods: This was descriptive study of retrospective data of 187 fracture shaft of femur. Data from all the patients with fracture shaft of femur in the age group of 17 to 70 years admitted and operated between September 2018 to September 2022 were analyzed with magnitude of ipsilateral fracture neck of femur diagnosed preoperatively or postoperatively as main variable. Descriptive statistics was used to calculate frequency and percentage. Results: Out of 187 fracture shaft of femur, 8.02% (n=15) cases were associated with ipsilateral fracture neck of femur. 73.33% (n=11) cases of fracture neck of femur were identified preoperatively on plain radiograph whereas diagnosis of 26.66% (n=4) cases of fracture neck of femur was missed on initial evaluation and diagnosed on postoperative plain radiograph. Conclusions: Current study showed the magnitude of fracture neck of femur as 8.02% associated with ipsilateral fracture shaft of femur. Careful clinical evaluation, proper radiography of hip, possible CT scan in doubtful cases and intraoperative fluoroscopic evaluation of hip may decrease the incidence of missed diagnosis.

Cervical Fracture with Diffuse Idiopathic Skeletal Hyperostosis and Respiratory Insufficiency: A Case Report.

Case: Diffuse idiopathic skeletal hyperostosis (DISH) increases the risk of fracture due to low-energy trauma. We report the case of an 87-year-old man with a cervical fracture, DISH, and subsequent respiratory insufficiency and retropharyngeal arterial bleeding. Hemostasis was not achieved despite 10 coiling attempts. Arterial ligation, hematoma drainage, and C6/7 discectomy fusion were performed. The rupture of the ossified anterior longitudinal ligament was the most likely cause of the hemorrhage. The postoperative course was uneventful, and the patient was followed-up for 12 months.

OA09 Vertebral fractures on bisphosphonates

OA09 Vertebral fractures on bisphosphonates

A real-time deep learning approach for classifying cervical spine fractures

The first seven vertebrae of our spine are called the cervical spine. It supports the weight of our head, encloses and safeguards our spinal cord, and permits a variety of head motions. The seven cervical vertebrae are joined at the rear of the bone by a kind of joint known as a facet joint. These joints enable us to move our necks forward, backward, and twist. Fractures of the cervical spine are a medical emergency that may lead to lifelong paralysis or even death. If left untreated and undetected, these fractures can worsen over time. Using computed tomography, a cervical spine fracture in individuals can be accurately diagnosed. Given the scarcity of research on the practical use of deep learning methods in detecting spine fractures in persons, it is imperative to address this gap. This study uses a dataset containing fracture and normal cervical spine computed tomography images. This study proposed modified transfer-learning-based MobileNetV2, InceptionV3, and Resnet50V2 models. An ablation study was also conducted to determine the optimal custom layers for models and data augmentation techniques. In addition, evaluation metrics have been used to analyze and compare the model's performance. Among all the approaches, MobileNetV2 with augmentation has achieved the highest accuracy of 99.75%. Furthermore, the best-performing model has been deployed in a smartphone-based Android application.

Utilization of a two-material decomposition from a single-source, dual-energy CT in acute traumatic vertebral fractures.

The purpose of this study is to utilize a two-material decomposition to quantify bone marrow edema on a dual-energy computed tomography (DECT) scanner at the cervical, thoracic, and lumbar spine acute fractures in correlation with short tau inversion recovery (STIR) hyperintensity on magnetic resonance imaging (MRI) in comparison with the normal bone marrow. This retrospective institutional review board-approved study gathered patients over 18 years old who had acute cervical, thoracic, or lumbar spinal fractures scanned on a DECT scanner. Those who had a spinal MRI done with bone marrow STIR hyperintensity within 3 weeks of the DECT were included. The water (calcium) and fat (calcium) density (mg/cm3) measurements of the region of interest of the bone marrow were obtained at a normal anatomic equivalent site and at the fracture site where STIR hyperintensity was noted on MRI. A statistical analysis was performed using the paired t-test and Wilcoxon signed rank test (p > 0.05). A total of 20 patients met the inclusion criteria (males n = 17 males, females n = 3). A total of 32 fractures were analyzed: 19 cervical and 13 thoracolumbar. There were statistically significant differences in the water (43 ± 24 mg/cm3) and fat (36 ± 31 mg/cm3) density (mg/cm3) at the acute thoracic and lumbar spine fractures in correlation with edema on STIR images (both paired t-test <0.001, both Wilcoxon signed ranked test p < 0.01). There were no significant differences in the water (-10 ± 46 mg/cm3) or fat (+7 ± 50 mg/cm3) density (mg/cm3) at the cervical spine fractures. The DECT two-material decomposition using water (calcium) and fat (calcium) analyses has the ability to quantify a bone marrow edema at the acute fracture site in the thoracic and lumbar spine.

Association between cervical fracture patterns and blunt cerebrovascular injury when screened with computed tomographic angiography

Background CONTEXTPrior studies have demonstrated a close association between cervical spine fractures and blunt cerebrovascular injuries (BCVI). Undiagnosed BCVI is a feared complication because of the potentially catastrophic outcomes in a missed posterior circulation stroke. Computed tomography angiography (CTA) is commonly used to screen BCVI in the trauma setting. However, determining which cervical fracture patterns mandate screening is still not clearly known. PurposeThe aim of this retrospective review is to further elucidate which fracture patterns are associated with BCVI when using CTA and may mandate screening. Study Design/SettingRetrospective cohort study. Patient SampleAll patients that presented to our trauma and emergency departments with a blunt cervical spine fracture from January 2018 to December 2021. Inclusion criteria included blunt cervical trauma and the use of CTA for BCVI screening. Exclusion criteria included patients under the age of 18, penetrating cervical trauma, and use any imaging modality besides CTA for BCVI screening. Outcome MeasuresPatient demographics (age, gender, Glasgow coma scale, hospital length of stay (LOS), intensive care unit LOS, mechanism of energy of injury, polytrauma status), fracture location, fracture pattern (anterior arch, dens, dislocations/subluxations, facet, hangman, Jefferson, lamina, lateral mass, occipital condyle dissociation, occipital condyle, pedicle, posterior arch, spinous process, transverse process, transverse foramen, and vertebral body), and whether the patient sustained a BCVI or CVA. MethodsIf a patient had multiple fracture levels or fracture patterns, each level and pattern was counted as a separate BCVI. Multilevel fractures were defined as any patient with fractures at two distinct cervical levels. Differences between the patients who had a BCVI and those who did not were analyzed using independent sample t-tests for continuous variables and the chi-square or Fisher exact test for categorical variables. Odds ratios and 95% confidence intervals were calculated to assess likelihood between patient characteristics/fracture characteristics and BCVI. ResultsA total of 690 patients were identified as having a blunt cervical spine injury. A total of 453 patients (66%) underwent screening for BCVI with CTA. Among patients who underwent CTA, BCVI was diagnosed in 138 patients (30%), VAI in 119 patients (26%), CAI in 30 patients (7%), and 11 patients were diagnosed with both a VAI and CAI (2%). Overall, among all patients there were 9 strokes, all in patients identified with a BCVI (1%). No individual cervical level was associated with increased risk of BCVI, but when combined, OC-C3 fractures were associated with an increased risk (OR: 1.4, 95% CI: 1.0–1.9, p-value: .006). Multilevel fractures were also associated with an increased risk (OR: 1.7, 95% CI: 1.1–2.3, p-value: .01). The only fracture pattern associated with increased risk of BCVI were fractures associated with a dislocation/subluxation (OR: 3.8, 95% CI: 1.9–7.8, p-value = .0001). ConclusionsThe only fracture pattern associated with an increased risk of BCVI were fractures associated with dislocation/subluxation. The only fracture levels associated with BCVI were combined OC-C3 and multilevel fractures. We recommend that any upper cervical fracture (OC-C3), multilevel fracture, or fracture with dislocation/subluxation undergo screening for BCVI.

Atlantoaxial Subluxation with Atlas and Hangman’s Fractures: A Case Report

Combined dislocation and fracture of the upper cervical spine in adults is a rare condition that may result in devastating consequences. With the increase in road traffic accidents and the improvement in prehospital emergency care, serious injuries of the upper cervical spine are more frequently diagnosed at tertiary care centers. We report a case of a 19-year-old adolescent with dislocation-fracture of the upper cervical spine following a moderate-energy trauma. With early diagnosis and treatment, the patient showed good progress without major complications and 24-month follow-up.

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine.

Introduction: Despite the wide availability of clinical decision rules for imaging of the cervical spine after a traumatic injury (eg, NEXUS C-spine rule and Canadian C-spine rule), there is significant overutilization of computed tomography (CT) imaging in patients who are deemed to be at low risk for a clinically significant cervical spine injury by these clinical decision rules. The purpose of this study was to identify the major factors associated with the overuse of CT cervical spine imaging using a logistic regression model. Methods: This was a retrospective review of all adult patients who underwent CT cervical spine imaging for evaluation of a traumatic injury at a tertiary academic emergency department (ED) and three affiliate community EDs in January and February 2019. We performed multivariable logistic regression to identify factors associated with obtaining CT cervical spine imaging despite low-risk classification by the NEXUS C-spine Rule. Results: A total of 1,051 patients underwent CT cervical spine imaging for traumatic indications during the study period, and 889 patients were included in the analysis. Of these patients, 376 (42.3%) were negative by the NEXUS C-spine rule. Variables that were associated with increased likelihood of unnecessary imaging included age over 65, Emergency Severity Index (ESI) score 2 and 3, arrival as a walk-in, and anticoagulation status. Patients who presented to the tertiary academic ED had a significantly lower likelihood of unnecessary imaging. Twenty-one patients (2.4%) were found to have cervical spine fractures on imaging, two of whom were negative by the NEXUS C-spine rule, but neither had a clinically significant fracture. Conclusion: Cervical spine imaging is vastly overused in patients presenting to the ED with traumatic injuries, as adjudicated using the NEXUS C-spine rule as a reference standard. Older age, ESI level, arrival as a walk-in, and taking anticoagulation drugs were associated with overutilization of CT imaging. Conversely, presenting to the tertiary academic ED was associated with a lower likelihood of undergoing unnecessary imaging. This model can guide future interventions to optimize ED CT utilization and minimize unnecessary testing.

Cycling-related cranio-spinal injuries admitted to a Major Trauma Centre in the cycling capital of the UK

Background The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK. Methods We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender. Results A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = −0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes. Conclusion As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention.

Comparison of Anterior Cervical Discectomy Fusion Combined with Lateral Mass Screw and with Cervical Pedicle Screw Fixation Surgery under O-Arm Navigation for Single-Stage Management of Severe Lower Cervical Fracture Dislocation.

The incidence of severe lower cervical fractures and dislocations due to trauma has increased significantly, and the optimal treatment remains controversial. This study compares the safety and efficacy of anterior cervical discectomy fusion (ACDF) combined with lateral mass screw (LMS) and with cervical pedicle screw (CPS) fixation surgery under O-arm navigation as single-stage treatments of severe lower cervical fracture dislocations. Data from 48 patients who underwent ACDF + CPS (Group A) or ACDF + LMS (Group B) for severe lower cervical fracture dislocation between January 2016 and September 2020 were retrospectively reviewed. Groups A and B comprised 25 and 23 cases, respectively. Clinical parameters, such as operative time, intraoperative blood loss, number of fixed segments, posterior incision length, operative complications, and hospitalization days were recorded. Preoperatively and postoperatively, the sub-axial injury classification (SLIC) score, the American Spinal Injury Association (ASIA) impairment scale, and the Japanese Orthopaedic Association (JOA) score were recorded and analyzed using Student's t-test. The SLIC scores were 7.1 ± 1.2 and 7.5 ± 1.1, ASIA were 1.5 ± 0.6 and 1.2 ± 0.6, JOA score improvements were 3.2 ± 2.4 and 3.0 ± 2.1, operative times were 282.1 ± 91.7 and 266.5 ± 88.2 min, intraoperative blood losses were 437.8 ± 118.5 and 418.7 ± 104.2 mL, fixed segments were 2.8 ± 0.7 and 4.8 ± 1.1, and lengths of posterior incisions were 12.7 ± 2.8 and 13.8 ± 3.2 cm in Groups A and B, respectively. There was no significant difference between the two groups in the operative time, intraoperative blood loss, incision length, and postoperative recovery; however, group A had more fixed segments. At the final follow-up, no intraoperative or postoperative complications directly caused by the implant were present. Throughout the follow-up, all cases showed recovery and progressive improvement. Both ACDF + LMS and ACDF + CPS under O-arm navigation can safely and effectively restore cervical vertebral sequence, fully release spinal canal compression, and promote patients' neurological recovery. Thus, both are effective treatments for severe lower cervical fracture dislocations. However, compared to LMS, CPS under O-arm navigation has shorter fixed segments and induces less trauma.

264 Observational Study of Clinical Impact of E-Scooter Injuries at Major Trauma Centre

Abstract Aim Is to focus on frequency E-scooter associated injuries especially open fractures and to see its burden on health system. Method Data of E-scooter injuries was extracted from trauma database from November 2017 to July 2022. Outcome measures were type of injuries: site of bony fractures, closed Vs open fracture, number of operations, complications and Length of Hospital Stay. Results Number of patients enrolled was 104. The mean age was 34.3 years and 78.8% were males. The main mechanism of injury was riding 91%. Patients with bony injuries were 65.4% with 22.1% of them were open fractures. Most common bony injuries were lower limb only fractures 45.6%, then upper limb only injuries 39.7%. Head and neck injuries composed 23.1% of the reported injuries including: intracranial haemorrhages (9.6%), extensive traumatic brain injury (3.8%), hematoma/lacerations (3.8%), cervical spine fractures (1.9%) and skull fractures (1.9%). Mean duration of hospital stay was 8.6 days and 9.6% patients needed ITU admission. Number of patients presented as trauma calls were 55.8%. Patients that needed surgical intervention either under Orthopaedics or other specialities were 52.9% and 21.2% of total patients had complications either due to surgical intervention or long hospital stay. Conclusions E-scooter riding can lead to serious injuries that can end with limb or life-threatening conditions. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.

261 Bilateral Femoral Neck Stress Fractures in an Active Adolescent Female: A Case Report

Abstract Bilateral femoral neck stress fractures are uncommon injuries in adolescents. We present such a case in a 15-year-old athletic female with no preceding trauma or underlying metabolic bone abnormality. The patient presented to Accident and Emergency with a three-week history of left buttock and lateral thigh pain and one-week history of right lateral thigh pain. The pain developed during physical activity and was relieved upon rest. Activities included running, dancing, and attendance at a six-week cadet marching course. Simple analgesia did not alleviate the pain. History revealed low caloric intake and previous secondary amenorrhea. The patient was previously managed by the General Practitioner and physiotherapist for suspected atypical sciatica. Physical examination showed a minimally antalgic gait and pain on palpation of the left groin. Both hips had full range of motion. Bone profile was normal. Radiographic films were initially interpreted as normal, however, formal reporting revealed sclerotic appearances to both femoral necks and a subtle break in the left femoral neck cortex. MRI confirmed the diagnosis of a complete displaced left femoral neck fracture and incomplete right inferomedial femoral neck fracture. Trace bilateral hip joint effusions were noted. The patient underwent bilateral fixation with cannulated screws. One-month post-operative, she engaged in walking and swimming without pain. Radiographic appearances were satisfactory. Early radiographic changes associated with stress fractures are subtle. This case highlights the importance of prompt formal radiological reporting and the early use of MRI as a diagnostic tool, particularly in patients with risk factors.