Open Injuries Research Articles

Metabolic abnormalities underlying nonunion in the adult fracture patient

Introduction: The objective of this study is to comprehensively evaluate fracture type, category of nonunion, and metabolic profile to identify metabolic causes that may impact fracture union. Methods: A retrospective chart review of patients diagnosed with nonunion after fracture fixation was performed. Patient demographics, fracture characteristics, and metabolic profiles were assessed. Results: Data was collected from 94 patients with nonunion, with a mean age of 54.7 years, 50% men, 47.3% obese, and 60.8% current/former smokers. The most common nonunited bone was the femur (48%), tibia (22%), humerus (15%), ulna (5%), clavicle (3%), and fibula (2%). The distal femur, femoral shaft, and tibial shaft made up 50% of the nonunion. The intra-articular fracture was diagnosed in 13% and open injuries in 27%. The most common metabolic abnormalities were low hemoglobin (62.3%), elevated neutrophil percentage (61.9%), elevated erythrocyte sedimentation rate in women (51.8%), low testosterone (46.9%), and hypovitaminosis D (44.3%). Conclusion: The prevalence of metabolic abnormalities was documented across all nonunion types, suggesting this is not unique to atrophic nonunion. Given the high morbidity and cost of nonunion, and low cost of vitamin supplementation, future prospective studies are warranted to identify effective prevention and treatment.

INCLUSION OF OPEN INJURIES IN AN UPDATED SCHENCK CLASSIFICATION OF KNEE DISLOCATIONS BASED ON A GLOBAL DELPHI CONSENSUS STUDY

AbstractIntroductionKnee dislocations (KDs) are complex injuries which are often associated with damage to surrounding soft tissues or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system.MethodsA global panel of orthopaedic knee surgery specialists participated in a Delphi process. A list of factors to be included in a KD classification system was formulated by 91 orthopaedic surgeons, which was subsequently prioritised by 27 experts from 6 countries. The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system.ResultsThe four factors that reached consensus agreement and thus deemed critical for inclusion in a classification system were vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%).ConclusionThe wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. The Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injuries. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier.

Spontaneous closure of transverse loop colostomy: A case report

Colostomy is an artificial colo-cutaneous fistula which can be temporary or permanent, depending on the purpose for which it was created. The indications for colostomy include protection of a distal intestinal anastomosis, control of sepsis in open injury to the colon or rectum, to facilitate the operative treatment of a high anal fistula

Neuron Specific Enolase Levels’ Relationship with CT Scan Images on Head Injury Patients

Head injuries can cause closed injuries, or open injuries that can penetrate the skin, starting from the skin as the outermost layer, to the bones of the skull, blood vessels of the brain, and brain tissue as cranio-cerebral injuries. The authors wanted to prove whether there is a picture between NSE serum levels and a CT scan of the head that describes the severity of a head injury. The type of research used in this research is analytic observational research. The study design in this study was a cross sectional which aims to describe the levels of Neuron Specific Enolase (NSE) serum with CT scan images of head injured patients at RSUP Dr. M. Djamil City of Padang. This research was conducted in the Emergency Room of RSUP Dr. M. Djamil, Padang City as the sampling location and the Biomedical Laboratory of the Faculty of Medicine, Andalas University as the research location and the research time starts from February to June 2023. Head injury patients who underwent head CT scans at the M.Djamil Hospital Padang Emergency Room were found with the following characteristics: age 20-29 years, male sex, CT scan of the head in the form of MLS<5mm/cistern narrowing, increased NSE level, severity mild head injury (GCS 13-15).

Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus

To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus. From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor. There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05). In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.

Persistent Infection in a Patient with Tibial Non-union

This report presents a case of persistent pin site infection that resulted in the removal of hardware in a patient who underwent Ilizarov stabilization for compound tibial fractures. Despite antibiotics, the infection worsened, necessitating removal of the entire Ilizarov frame to prevent permanent damage or non-union. Bone marrow stimulators were subsequently placed for healing support. The report emphasizes the importance of rigorous pin site care, meticulous monitoring, low threshold for diagnosis of complications and swift escalation of treatment when needed. However, vigilance alone may not be enough, especially in those with co-morbidities, open injuries or hardware applications simplifying opportunities for nosocomial infection. The patient's recovery process involved early, optimized rehabilitation, medical and social supports, leading to a return to partial mobility and function despite a prolonged recovery process. Diligent follow-up was necessary at each stage to recognize complications before permanent damage and revise treatment plans as needed. The report aims to share lessons learned and strengthen preparedness for future cases facing similar challenges. Success emerged from determination, vigilance and partnership. Close monitoring makes the difference between catastrophic loss and maximal benefit from an ordeal already threatened by overcoming disability.

Wound Complications Following Olecranon Fracture Fixation: Implant and Soft Tissue Considerations.

The aim of this multicenter, retrospective, case-control series was to investigate patient- and treatment-specific factors associated with wound breakdown following olecranon fracture fixation. Methods: We identified patients at our two participating academic centers who were operatively treated for olecranon fractures and those who subsequently underwent a re-operation secondary to postoperative wound breakdown. Demographic and historical information was collected, including BMI and Charlson comorbidity index (CCI) scores. The primary outcome measure was the standardized radiographic measurement of plate prominence and soft tissue thickness posterior to the plate tip. Results: We identified 32 patients who underwent internal fixation and subsequent wound breakdown. This was compared to a cohort of 35 matched controls that did not have wound issues. Cases with wound breakdown were of higher energy, nine being open cases compared to two in the control group (p<0.05). No differences were identified in plate prominence, soft tissue thickness, and plate type. Conclusions: Wound breakdown following olecranon fracture fixation is more commonly seen in high-energy open injuries. Plate prominence, soft tissue thickness, and patient-specific factors do not correlate with wound breakdown. Further investigation into the factors influencing plate placement and how they may contribute to wound complications is needed.

Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients.

Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Relationship between Time to Surgical Debridement and Rate of Wound Infection in Open Tibia Fracture in a Tertiary Care Hospital

Background: The most frequent open long bone injury requiring immediate surgical intervention is an open tibial fracture. Within 6 hours of the injury, emergent surgical debridement of an open tibia fracture is advised by current guidelines. Recently, the 6-hour rule became challenged and delaying in debridement of an open fracture may be unethical. Methods: This cross-sectional study was carried out to assess the relationship between time of surgical debridement and rate of infection after open fracture tibia at National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) on 608 patients with open fracture tibia (all Gustilo types) within 24 hours of injury from January 2018 to October 2019. Results: The mean age of the 608 patients was 36.2±15.5 years. The foremost mechanism of injury was road traffic accident (72.0%) and among the associated injuries, concomitant soft tissue injury (32.5%) was prevalent. Gustilo III was predominant injury (72.1%) and infection rates among the Gustilo subtype II was predominant (31.3%). After debridement 73 (12.0%) patients were contamination free. A significant association was found in the contamination rate between surveillance culture and post-debridement culture (p=0.000). Positive correlation found between debridement done ≥6 hours and infection present in 3rd culture from ward (r=0.237). Conclusion: The study insights that injury characteristics, infection pattern and infection rate of open fracture tibia. Delay in debridement has a significant relationship with wound infection, with more virulent multidrug resistance phenotypes.

Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures.

To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. A tsurg > 48h was associated with increased rate of delayed unions (tsurg < 48h: 25% vs tsurg > 48h: 59%, p = 0.03), but not complications (tsurg < 48h: 44% vs tsurg > 48h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48h was also seen, but did not reach significance (tsurg < 48h: 13.5weeks vs tsurg > 48h: 15.7weeks, p = 0.11). A tsurg > 48h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. Therapeutic Level III (Retrospective Cohort).

A practical clinical approach to traumatic choroidal rupture

Background: Traumatic choroidal rupture is a posterior segment manifestation of trauma and is more common in closed-globe injuries. It is defined as a tear of the choroid and Bruch’s membrane following blunt trauma. This narrative review summarizes the current literature and provides a practical clinical approach to the diagnosis and management of traumatic choroidal rupture and its complications. Methods: In this narrative review, we searched the PubMed/MEDLINE database using the search term choroidal rupture to provide a practical and updated approach to traumatic choroidal rupture, focusing on its definition, etiology, diagnosis, imaging, management of complications, and prognosis as mentioned in the literature over the last two decades. Results: Traumatic choroidal rupture occurs due to increased tensile stress on the eye wall and is three-fold more common in closed-globe injuries than in open injuries. Subretinal or sub-retinal pigment epithelial hemorrhage and macular edema are early signs. Macular involvement is associated with poor visual prognosis. Damage to Bruch’s membrane increases the risk of subretinal choroidal neovascular membrane (CNVM). Traumatic epiretinal membrane is another complication. Imaging modalities such as spectral-domain optical coherence tomography, indocyanine green angiography, conventional fundus fluorescein angiography, and optical coherence tomography angiography (OCT-A) can be used in diagnosis or monitoring for complications. OCT-A offers unique opportunities for the diagnosis, treatment, and follow-up of both the initial presentation and possible complications. Frequent follow-up has been suggested in the first year after trauma. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection is effective and less invasive in managing CNVM. The visual outcome depends on the location of the rupture, baseline visual acuity, and presence of optic atrophy or macular holes. Risk factors for developing CNVM include rupture involving the macula, longer rupture length or rupture closer to the foveal center, and older age. Conclusions: Choroidal rupture is a posterior segment entity that usually occurs after trauma, compromises choroidal vessels and Bruch’s membrane, and can lead to CNVM. The use of novel noninvasive imaging modalities and efficient anti-VEGF therapy to manage this entity or its subsequent complications produces better visual outcomes. Early diagnosis and frequent follow-up of these patients allow treatment of possible complications, thereby improving the visual prognosis.

Functional Outcomes After High-Energy Lisfranc Injuries.

Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury. A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome. Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, P = .04), distal tibia (33, P = .04), and talus (25.3, P = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, P = .008) and total FFI scores (35.9 vs 26, P = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI (P < .05) and SMFA emotion and bothersome scores (P < .04). Chronic renal disease was a predictor of worse FFI disability (P = .04) and SMFA subcategory scores (P < .04). Male sex was associated with better scores in all SMFA categories (P < .04). Age, obesity, or open injury did not affect functional outcomes. Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury. Level IV, retrospective, prognostic.

Right-to-Left Displacement of an Airgun Lead Bullet after Transorbital Entry into the Skull Complicated by Posttraumatic Epilepsy : A Case Report.

Penetrating head injury is a serious open cranial injury. In civilians, it is often caused by non-missile, low velocity flying objects that penetrate the skull through a weak cranial structure, forming intracranial foreign bodies. The intracranial foreign body can be displaced due to its special quality, shape, and location. In this paper, we report a rare case of right-to-left displacement of an airgun lead bullet after transorbital entry into the skull complicated by posttraumatic epilepsy, as a reminder to colleagues that intracranial metal foreign bodies maybe displaced intraoperatively. In addition, we have found that the presence of intracranial metallic foreign bodies may be a factor for the posttraumatic epilepsy, and their timely removal appears to be beneficial for epilepsy control.

Analysis of regional features of the tibial plateau fractures in the Rostov region

Background. The prevalence of tibial plateau fractures reaches 51.7 per 100,000 population per year, accounting for approximately 1% of all fractures, and is associated with the development of post-traumatic knee osteoarthritis in 25-45% of cases.&#x0D; The aim of this study was to investigate the regional features, including frequency, structure, and outcomes, of S82.1 fractures.&#x0D; Methods. An anonymized sample was obtained from the regions database, covering the period from 2017 to 2021, using the ICD-10 codes S82.1, Z47.0, M17.2, and M17.3. Data Science principles and software were applied for analysis.&#x0D; Results. A total of 14,705 records were obtained. The average prevalence of tibial plateau fractures in the region was 24 per 100,000 population per year. The frequency of fractures was highest among the working-age population, with a male-to-female ratio of 1.02:1.00. There was a shift in the age group of knee osteoarthritis occurrence to individuals over 60 years old. Since 2018, a decrease in the number of fractures has been observed among elderly individuals. Out of the total sample, 1,017 patients were hospitalized, and 1,752 operations were performed. Open injuries accounted for 1.9% of cases, and the complication rate was 5.3%. Moderate correlations were found between open fractures, complicated course, and inpatient treatment costs (0.42r0.3). The probability of developing knee osteoarthritis within a five-year period was 0.0161. The average age of men with knee osteoarthritis was 517 years, while for women, it was 607 years. The younger age of osteoarthritis onset in men may be associated with a higher prevalence of severe fractures. The average cost of inpatient treatment increased from 26,533 rubles in 2017 to 34,682 rubles in 2021, significantly exceeding the cost of outpatient treatment.&#x0D; Conclusion. Tibial plateau fractures (S82.1) predominantly occur among economically active men. The decrease in the proportion of elderly individuals with fractures in the years 2019-2021 may be explained by a decrease in the elderly population in the region and the impact of pandemic-related restrictions. The compulsory health insurance system incurs the highest costs during inpatient care. It is advisable to include classification features of fractures according to the OA/OTA system in databases to facilitate more accurate planning and differentiation of treatment expenses.

A Regional Analysis of Potentialy Preventable Injuries Sustained from Burning Garbage and Yard Waste.

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This five-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136-patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1, Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a three-fold higher length of stay (10 vs 3 days; p = 0.023). Patients with lower pre-injury functionality had almost 4 times higher mortality (23.7% vs 6.3%; p = 0.085). There were 9 (6.7%) deaths with an average (± SD) 74.3 ± 13.1 years of age, median 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste burning injuries.

Efficacité de la fixation interne précoce associée à un lambeau libre pour le traitement des fractures ouvertes de l’avant-bras Gustilo IIIB

IntroductionGustilo IIIB open forearm fractures are severe injuries often associated with extensive bone and soft tissue injuries. The treatment of Gustilo IIIB open forearm fractures remains a challenging problem, with a high morbidity rate such as infection, nonunion, even amputation. External fixation is preferred for open lower limb fractures. However, there are significant differences between open bone injuries of the upper and lower extremity in terms of treatment plans. Use of internal fixation methods for open fractures is a controversial issue, as it requires early coverage of skin and soft tissue defects after radical debridement and irrigation. The optimal approach for open forearm fractures remains to be determined. The present study evaluated whether early internal fixation combined with free flap placement is effective for the treatment of Gustilo IIIB open forearm fracture. HypothesisEarly internal fixation combined with the free flap technique in the treatment of Gustilo IIIB open forearm fracture provides good consolidation results. Material and methodsFrom January 2015 to January 2020, 20 patients with Gustilo IIIB open forearm fracture treated with early internal fixation combined with free skin flap placement were retrospectively analyzed. There were 9 males and 11 females, with an average age of 40years. In all cases, the injuries were classified as Gustilo type IIIB. The area of the wounds ranged from 9×3cm to 27×10cm. Fist-stage plate fixation was adopted in 16 cases. Four patients presenting with major contamination received first-stage fixation with Kirschner wires and external fixation, and the second-stage surgery of surgical treatment included flap placement and internal fixation within 10days. The rates of limb salvage and complications were recorded. The Anderson scoring system was utilized to assess limb function. ResultsLimb salvage was successful in all 20 cases. The average length of hospital was 19 days (range, 7–28days). Four patients developed superficial infections. After debridement, the wounds were covered with skin grafts. No deep infections or osteomyelitis occurred. Three patients developed nonunion, and bone grafts achieved bone healing later. The donor skin flaps healed well, with partial pigmentation. No complete necrosis of the flaps occurred. Only the distal part of flaps became necrotic in two cases, which were then successfully treated by debridement and skin grafting. The average follow-up duration was 14.7months (range, 8–24months). According to the Anderson scoring system, 7 cases were graded as excellent, 6 cases as good, 5 cases as fair, and 2 cases as poor. ConclusionFor Gustilo IIIB type injuries, early and thorough debridement along with early internal fixation and skin flap coverage of the wound can achieve satisfactory clinical results, shorten the treatment cycle, and maximize limb function recovery. Level of evidenceIV; retrospective study without control group.

Имплантация интраокулярной линзы при травматической катаракте: сроки и перспективы

A prospective randomized clinical trial included 30 patients (60 eyes) with traumatic cataract after open eye injury. Patients were divided into 2 groups depending on the time of the operation. The first (n = 15, 30 eyes) was an early operation (1–3 days after the injury). The second (n = 15, 30 eyes) is a late operation (6 or more days after the injury). Research methods – measurement of visual acuity, intraocular pressure (IOP), assessment of inflammation of the anterior chamber, position of the intraocular lens (IOL), etc. The study period was 1, 3, and 6 weeks after surgical treatment. It was revealed that visual acuity with the best correction was noted 6 weeks after the early operation. Also in the group of early cataract surgery, the frequency of postoperative complications (rupture of the posterior capsule, increased IOP, inflammation of the anterior chamber, IOL opacity, posterior synechia, IOL subluxation and pigment deposition on the IOL) was significantly lower than in the late surgery group (p &lt; 0.05). It is recommended to perform cataract surgery and IOL implantation after open eye injuries at an early stage. Keywords: surgery, traumatic cataract, vision, intraocular lens implantation

Epidemiology of Cranial Infections in Battlefield-Related Penetrating and Open Cranial Injuries.

Penetrating brain injuries are a potentially lethal injury associated with substantial morbidity and mortality. We examined characteristics and outcomes among military personnel who sustained battlefield-related open and penetrating cranial injuries during military conflicts in Iraq and Afghanistan. Military personnel wounded during deployment (2009-2014) were included if they sustained an open or penetrating cranial injury and were admitted to participating hospitals in the United States. Injury characteristics, treatment course, neurosurgical interventions, antibiotic use and infection profiles were examined. The study population included 106 wounded personnel, of whom 12 (11.3%) had an intracranial infection. Post-trauma prophylactic antibiotics were prescribed in over 98% of patients. Patients who developed CNS infections were more likely to have undergone a ventriculostomy (p = 0.003), had a ventriculostomy in place for a longer period (17 vs 11 days; p = 0.007), had more neurosurgical procedures (p < 0.001), and have lower presenting Glasgow Coma Scale (GCS, p = 0.01), and higher Sequential Organ Failure Assessment (SOFA) scores (p = 0.018). Time to diagnosis of CNS infection was a median of 12 days post-injury (interquartile range [IQR]: 7-22 days) with differences in timing by injury severity (critical head injury had median of 6 days while maximal (currently untreatable) head injury had median of 13.5 days), presence of other injury profiles in addition to head/face/neck (median of 22 days), and the presence of other infections in addition to CNS infections (median of 13.5 days). The overall length of hospitalization was a median of 50 days and two patients died. Approximately 11% of wounded military personnel with open and penetrating cranial injuries developed CNS infections. These patients were more critically injured (e.g., lower GCS and higher SOFA scores) and required more invasive neurosurgical procedures. Level III; Prognostic/Epidemiological.

Achilles Tendon Injuries in the Pediatric Population.

Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries. A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings. Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9). We found that older adolescents (≥14y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population. Level-IV.

36 A Regional Analysis of Completely Preventable Injuries Sustained from Burning Garbage and Yard Waste

Abstract Introduction Burn injuries due to garbage and yard waste burning account for a high percentage of flame injuries in the south. Understanding the injury pattern and healthcare burden is important for effective prevention of these completely unnecessary burn injuries. Methods This five-year retrospective, single-center, review included patients admitted between 2016 and 2021. Patients included were at least 14 years of age and sustained an open flame burn injury due to burning brush and/or trash. Patients who experienced a burn injury due to gasoline, hazardous material, lighter, fireworks, accelerant/gel, aerosol can, and burning bedding/clothing, were excluded. Results Based primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment (not included in taxes), and 18% did not have access to municipal waste disposal. The median age was 50 (32, 66.5) years. The majority were burning yard debris, while 32% were burning trash. The majority were male (85%) and Caucasian (71%). The median TBSA was 5 (2.5, 12) percent with 36% having some portion of full-thickness injury. One-third had some form of substance use with 29% tobacco, 5% alcohol, and 4% illicit drugs. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 unnecessary hospital days utilized (~6.6% of available bed-days per study period). The median length of stay was 3 (1, 10) days with the majority (85%) being discharged back to their home. Twenty-five percent were discharged with a paired functional status worse than pre-injury. Eighty-eight percent required no assistance prior to injury, while only 67% were discharged without requiring mobility or assistance with ADLs. Patients with some degree of pre-injury function limitations had a three-fold higher LOS (10 vs 3 days; p = 0.023) and associated costs. Although deaths were few in this sample, patients with lower pre-injury functionality had almost 5 times higher mortality (23.1% vs 5.3%; p = 0.083). Therapy data were available for 88 patients totaling 656 occupational and 462 physical therapy sessions, including acute care, inpatient rehabilitation unit, and outpatient. Unfortunately, there were 8 (6%) unnecessary deaths from their injuries with an average 77.3 ± 10.4 years of age and 42.4 ± 21.7% TBSA with 35.1 ± 23.7% being full-thickness. Total hospital charges exceeded $32.6 million with a median $32,952.26 ($8,790.48, $103,113.95) per patient. Payer source at day of discharge was mixed (private 37%, self-pay 26%, Medicare 20%, and Medicaid 17%). Conclusions Injuries from waste burning are completely unnecessary and subsequent mortality, morbidity, and health care burden avoidable. Focusing future outreach efforts on education and resource availability may prevent future debris and trash related injuries. Applicability of Research to Practice This is the first study to utilize repository data to analyze waste burning injuries from a regional perspective.