Injury Patterns Research Articles

SP7.4 - Analyzing Geriatric Trauma Patterns: Prevalence, Injury Types, and Transfer Delays in Riyadh, Saudi Arabia

Abstract Aim To analyze geriatric trauma prevalence, injury pattern, transfer delays to trauma centers, and assess undertriage to non-trauma centers in Riyadh City. Method We conducted a retrospective review of 11,140 incident reports from 50 Red crescent Center in Riyadh City from the official data registry of the Red Crescent of Saudi Arabia from January 2021 to March 2023. Cases meeting "red criteria" (SBP < 110 mmHg or HR > SBP) were identified. Using QGIS, we mapped the regional distribution of dispatch and non-trauma centers. Network service zone analysis delineated level 1 and 2 trauma center service areas reachable within 15-, 30-, 45-, and 60-minute intervals. Dispatch centers were grouped to assess mistriaging of red criteria cases. Delays were defined as travel time >60 minutes to a non-trauma center. Data were analyzed using SPSS 26 and R statistics. Results Majority of geriatric trauma patients (65.6%, n=7312/11140) were classified under red criteria. Penetrating injuries were the most common (51.2%, n=5704/11140), followed by fall-related injuries (38%, n=4234/11140), and finally motor vehicle accidents (6%, n=669/11140). Among red criteria cases, majority of the patients (65.6%, n=2360/3419) transferred to level 1 and 2 trauma centers were delayed, most commonly seen in the 15-minute area of south and middle Riyadh and the 45-minute service area of northern and southern Riyadh. Nearly of quarter of the red criteria patients (23.54%, n=1721/7312) were transferred to a non-trauma center. Conclusions Addressing delays in accessing trauma centers and transfers to non-trauma facilities is imperative, warranting focused intervention. Addressing preventable delays and enhancing the capabilities of Red Crescent centers are vital for improving geriatric trauma care in Riyadh.

Impacts of Anthropogenic Emissions and Open Biomass Burning in South Asia and Southeast Asia on Air Quality and Meteorology Over Southern China

AbstractThe emissions from South Asia and Southeast Asia significantly impact air quality and meteorological conditions in China. However, the individual or joint contributions of anthropogenic emissions and/or biomass burning from outside China to surface particulate matter with aerodynamic diameters less than 2.5 μm (PM2.5) and aerosol optical depth (AOD) over southern China have not been fully investigated. Here, five experiments were designed to investigate the impacts of these emissions in January (winter), March (pre‐monsoon), and October (post‐monsoon) for 2017. Aerosols from South Asia and Southeast Asia contributed less to southern China during winter and post‐monsoon seasons, whereas the wind patterns and emission intensity during the pre‐monsoon season were conducive to the transport of aerosols. During pre‐monsoon season, the total emissions contributed approximately 5.0 μg m−3 to surface PM2.5 in Xizang Province. Biomass burning in Southeast Asia increased PM2.5 in Yunnan Province by 37.9 μg m−3, while anthropogenic emissions increased it by 8.9 μg m−3. Transboundary aerosols can be transported to Xizang Province and Yunnan Province, primarily influencing PM2.5 below 2 km height. It mainly affected PM2.5 levels above the planetary boundary layer over southeast China. Aerosols from outside China can account for 79.5% and 54.8% AOD in Yunnan Province and southeast China, respectively. These aerosols reduced surface incident solar radiation by approximately 6%, leading to decreases in air temperature, wind speed, and boundary layer height. The findings are only applicable to the pre‐monsoon season.

Histologic Features of Liver Injury Associated With SARS-CoV-2 Messenger RNA Vaccines.

Many drugs can induce liver injury; however, vaccine-induced liver injury is a rare phenomenon. SARS-CoV-2 messenger RNA (mRNA) vaccines are now widely administered, and clinical evidence of liver injury has been reported. To characterize the histologic features of SARS-CoV-2 mRNA vaccine-associated liver injury. Thirteen liver biopsies from 12 patients with elevated liver enzymes clinically favored to be secondary to SARS-CoV-2 mRNA vaccine were identified between 2021 and 2022. Demographics, clinical information, and histologic features of liver biopsies were reviewed. All patients (median age, 58 years; M:F = 4:8) received at least 1 dose of SARS-CoV-2 mRNA vaccines (7 Pfizer and 5 Moderna). Four patients had a history of liver disease. Nine patients developed symptoms between 1 day and 2 months after receiving the vaccine dose. Viral serologies were negative. Drug-induced liver injury was thought to be less likely clinically in the 3 patients who had started new medications. Autoimmune antibodies were detected in 9 patients. Moderate to severe active hepatitis was the dominant histologic pattern of injury (9 of 13 biopsies; 69%). Resolving hepatitis, cholestatic hepatitic injury, and bile duct injury were identified in 1 biopsy each. All patients recovered spontaneously or with steroid therapy except one patient who developed autoimmune hepatitis. Moderate to severe active hepatitis is commonly observed in SARS-CoV-2 mRNA vaccine-associated liver injury, and female patients may be more susceptible to injury. Liver injury resolves spontaneously or with steroid treatment. In rare cases, these vaccines may trigger an underlying immune condition.

Spatial Analysis of Air Pollutants in an Industrial City Using GIS-Based Techniques: A Case Study of Pavlodar, Kazakhstan

The given research employs high-resolution air quality monitoring and contemporary statistical methods to address gaps in understanding the urban air pollution in Pavlodar, a city with a significant industrial presence and promising touristic potential. Using mobile air quality sensors for detailed spatial data collection, the research aims to quantify concentrations of particulate matter (PM2.5, PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ground-level ozone (O3); assess their distribution; and identify key influencing factors. In this study, we employed Geographic Information Systems (GISs) for spatial analysis, integrating multi-level B-spline interpolation to model spatial variability. Correlation analysis and structural equation modeling were utilized to explore the relationships between variables, while regression analysis was conducted to quantify these relationships. These techniques were crucial for accurately mapping and interpreting spatial patterns and their underlying factors. The study identifies PM2.5 and NO2 as the primary contributors to air pollution in Pavlodar, with NO2 exceeding the 24 h threshold in 87.38% of locations and PM2.5 showing the highest individual air quality index (AQI) in 75.7% of cases. Correlation analysis reveals a positive association between PM2.5 and AQI and a negative correlation between NO2 and AQI, likely due to the dominant influence of PM2.5 in AQI calculations. Structural equation modeling (SEM) further underscores PM2.5 as the most significant impactor on AQI, while NO2 shows no significant direct impact. Humidity is positively correlated with AQI, though this relationship is context-specific to seasonal patterns observed in May. The sectoral analysis of landscape indices reveals weak correlations between the green space ratio (GSR) and air quality, indicating that while vegetation reduces pollutants, its impact is minimal due to urban planting density. The road ratio (RR) lacks sufficient statistical evidence to draw conclusions about its effect on air quality, possibly due to the methodology used. Spatial variability in pollutant concentrations is evident, with increasing PM2.5, PM10, and AQI towards the east-northeast, likely influenced by industrial activities and prevailing wind patterns. In contrast, NO2 pollution does not show a clear geographic pattern, indicating vehicular emissions as its primary source. Spatial interpolation highlights pollution hotspots near industrial zones, posing health risks to vulnerable populations. While the city’s overall AQI is considered “moderate”, the study highlights the necessity of implementing measures to improve air quality in Pavlodar. This will not only enhance the city’s attractiveness to tourists but also support its sustainable development as an industrial center.

The non-haemorrhagic vagal response to trauma: a review of hypotensive and bradycardic responses to injury in the absence of bleeding.

Trauma has the potential to cause haemorrhage, tissue damage, pain, visceral manipulation and psychological distress. Each of these consequences of trauma can cause changes in autonomic outflow, which dictates a patient's vital signs. Patients who are hypotensive and bradycardic due to a vagally mediated parasympathetic response to pain, psychological distress and visceral manipulation may be confused with those who exhibit bradycardia and hypotension following significant blood volume loss. This review summarises literature that describes specific stimuli, patterns of injury and patient characteristics that are associated with a non-haemorrhagic vagal response to trauma. Twenty-six records described predominantly parasympathetic responses to trauma (both blunt and penetrating) and surgery ("iatrogenic trauma"). Such a non-haemorrhagic vagal response occurs following a wide variety of injury patterns. Patient age and sex are poor predictors of the likelihood of a non-haemorrhagic vagal response. The development and resolution of a non-haemorrhagic vagal response occurs over a heterogenous time period. It is unclear whether speed of onset and resolution is linked to the pattern of injury or other factors causing a predominantly parasympathetic response following non-haemorrhagic trauma. The pattern of injury, patient demographic and speed of onset / resolution associated with the non-haemorrhagic vagal response to trauma may is heterogenous. It is therefore challenging to clinically distinguish between the hypotensive bradycardia due to hypovolaemia secondary to haemorrhage, or a parasympathetic response to trauma in the absence of bleeding.

Characteristics of equestrian accidents and injuries leading to permanent medical impairment

BackgroundEquestrian sports, also referred to as equestrianism, is practiced all over the world and a popular leisure activity in Sweden. Equestrianism is the country’s second-largest youth sport, and previous studies indicate that accidents are common in equestrianism. However, few previous studies have examined acute equestrian injuries leading to permanent medical impairment (PMI).MethodsBy using nationwide insurance data comprising all injured equestrians registered in the Swedish Equestrian Federation, the aim was to analyse characteristics of equestrian accidents and particularly injuries leading to PMI, both in general and by age, gender, incident type, injury type and injured body region. Injury incidence and injuries leading to PMI were examined. All equestrians injured during 2017–2021 were included (n = 6,876), however, only injuries occurring in 2017 and 2018 were used to analyse the risk and the injury distribution of injuries leading to PMI. Injury incidence was calculated separately for males and females, as well as for different age groups, by dividing the number of insurance claims by the number of members multiplied by 1,000. Risk Ratio (RR) was calculated between gender. Pearson’s chi-squared test was used to analyse differences in distribution for categorical variables.ResultsThe majority of injuries affected females, correlating to approximately three times higher risk, compared to males. The age group 21–40 years were associated with the highest injury risk (14.26/1,000 registered riders). In total 12% of all injuries led to PMI. Injuries to the upper and lower extremities, along with fractures, had a higher risk of resulting in a PMI. The risk of injury leading to PMI was higher among riders over 20 years of age.ConclusionsThe fact that females face nearly three times the injury risk of males, and riders aged 21–40 had the highest injury risk while younger riders (Luke KL, McAdie T, Smith BP, Warren-Smith AK. New insights into ridden horse behaviour, horse welfare and horse-related safety. Appl Anim Behav Sci. 2022;246:105539.); (Havlik HS. Equestrian sport-related injuries: a review of current literature. Curr Sports Med Rep. 2010;9(5):299–302.); (Samuels K, Bettis A, Davenport DL, Bernard AC. Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns. Injury. 2022;53(1):171–5.); (Gharooni A-A, Anwar F, Ramdeep R, Mee H. Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre. Trauma. 2023;25(1):41–7.); (Hasler RM, Gyssler L, Benneker L, Martinolli L, Schotzau A, Zimmermann H, et al. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey. J Trauma Manag Outcomes. 2011;5:4.); (Meredith L, Brolin K, Ekman R, Thomson R. Analyses of injuries to equestrians in a Swedish district over a 16-year period. Translational Sports Med. 2019;2:270–8.) had a lower risk, indicates that preventive efforts should target both older and female riders. Injuries predominantly resulting in PMI involve upper and lower extremities, however, to prevent the most serious injuries significantly affecting a rider’s daily life, measures preventing head and spinal cord neck injuries, must be implemented. Head injures remain the most frequent, serious and most significant group of injuries to prevent and mitigate, within equestrian sports.

Transcriptome meta-analysis and validation to discovery of hub genes and pathways in focal and segmental glomerulosclerosis

BackgroundFocal segmental glomerulosclerosis (FSGS), a histologic pattern of injury in the glomerulus, is one of the leading glomerular causes of end-stage renal disease (ESRD) worldwide. Despite extensive research, the underlying biological alterations causing FSGS remain poorly understood. Studying variations in gene expression profiles offers a promising approach to gaining a comprehensive understanding of FSGS molecular pathogenicity and identifying key elements as potential therapeutic targets. This work is a meta-analysis of gene expression profiles from glomerular samples of FSGS patients. The main aims of this study are to establish a consensus list of differentially expressed genes in FSGS, validate these findings, understand the disease’s pathogenicity, and identify novel therapeutic targets.MethodsAfter a thorough search in the GEO database and subsequent quality control assessments, seven gene expression datasets were selected for the meta-analysis: GSE47183 (GPL14663), GSE47183 (GPL11670), GSE99340, GSE108109, GSE121233, GSE129973, and GSE104948. The random effect size method was applied to identify differentially expressed genes (meta-DEGs), which were then used to construct a regulatory network (STRING, MiRTarBase, and TRRUST) and perform various pathway enrichment analyses. The expression levels of several meta-DEGs, specifically ADAMTS1, PF4, EGR1, and EGF, known as angiogenesis regulators, were analyzed using quantitative reverse transcription polymerase chain reaction (RT-qPCR).ResultsThe identified 2,898 meta-DEGs, including 665 downregulated and 669 upregulated genes, were subjected to various analyses. A co-regulatory network comprising 2,859 DEGs, 2,688 microRNAs (miRNAs), and 374 transcription factors (TFs) was constructed, and the top molecules in the network were identified based on degree centrality. Part of the pathway enrichment analysis revealed significant disruption in the angiogenesis regulatory pathways in the FSGS kidney. The RT-qPCR results confirmed an imbalance in angiogenesis pathways by demonstrating the differential expression levels of ADAMTS1 and EGR1, two key angiogenesis regulators, in the FSGS condition.ConclusionIn addition to presenting a consensus list of differentially expressed genes in FSGS, this meta-analysis identified significant distortions in angiogenesis-related pathways and factors in the FSGS kidney. Targeting these factors may offer a viable strategy to impede the progression of FSGS.

Kidney Outcomes Following Angiotensin Receptor-Neprilysin Inhibitor vs Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Therapy for Thrombotic Microangiopathy.

Thrombotic microangiopathy (TMA) on kidney biopsy is a pattern of endothelial injury commonly seen in malignant hypertension (mHTN), but treatment strategies are not well established. To evaluate the kidney outcomes of angiotensin receptor-neprilysin inhibitor (ARNI), specifically sacubitril/valsartan, vs angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy for patients with mHTN-associated TMA. This single-center cohort study enrolled consecutive patients in China diagnosed with mHTN-associated TMA through kidney biopsy from January 2008 to June 2023. Follow-up was conducted until the conclusion of the study period. Data were analyzed in September 2023. Treatment with sacubitril/valsartan or ACEI/ARBs during hospitalization and after discharge. The primary outcome was a composite of kidney recovery: a 50% decrease in serum creatinine level, decrease in serum creatinine levels to the reference range, or kidney survival free from dialysis for more than 1 month. The secondary and tertiary outcomes were a 15% increase in the estimated glomerular filtration rate (eGFR) relative to baseline and kidney survival free from dialysis, respectively. Propensity score matching (PSM) and Cox proportional hazards regression analysis were used to evaluate the association between sacubitril/valsartan and ACEI/ARB therapy with kidney recovery outcomes. Among the 217 patients (mean [SD] age, 35.9 [8.8] years; 188 men [86.6%]) included in the study, 66 (30.4%) received sacubitril/valsartan and 151 (69.6%) received ACEI/ARBs at baseline. Sacubitril/valsartan treatment was associated with shorter time to the primary outcome compared with ACEI/ARB treatment (20 of 63 [31.7%] vs 38 of 117 [32.5%]; adjusted hazard ratio [aHR], 1.85; 95% CI, 1.05-3.23). Sacubitril/valsartan treatment was independently associated with shorter time to a 15% increase in eGFR (15 of 46 [32.6%] vs 46 of 83 [55.4%]; aHR, 2.13; 95% CI, 1.09-4.17) and kidney survival free from dialysis (11 of 23 [47.8%] vs 16 of 57 [28.1%]; aHR, 2.63; 95% CI, 1.15-5.88) compared with ACEI/ARB treatment. These differences remained significant in the PSM comparison. In this cohort study, sacubitril/valsartan treatment was associated with a potential kidney function benefit in patients with mHTN-associated TMA compared with ACEI/ARB treatment. The findings suggested that sacubitril/valsartan could be a superior therapeutic approach for managing this serious condition in terms of kidney recovery.

Injury Patterns in Fencing Athletes - A Retrospective Review.

Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. Cross-sectional. Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. 2b.

Profile of Ocular Trauma in Pediatric Population in a Tertiary Care Hospital

BACKGROUND Ocular trauma is the major cause for preventable monocular blindness and visual impairment worldwide. It accounts for 8%-14% of total injuries in the pediatric age group. Various studies have shown its higher incidence in this age group. They have different patterns of ocular injuries than adults and have age specific type of injuries. The number of blind years that a child lives with compared to an adult is far more. Most of the previous studies have been on ocular trauma among the adult population, specifically the factory workers in the city of Ludhiana. Moreover, this study aimed to derive a relation between the time of presentation from the injury and the final visual outcome which has rarely been reported in other studies. Profile of ocular trauma in an area is a dynamic and ever changing trend. Therefore, we proposed to study the profile of ocular trauma in pediatric population presenting to our hospital. METHODS A total of 60 patients between the age of 0 to 17 years were included in this study. The study was conducted from 15th December 2020 to 31st May 2022. Complete ocular examination was done at the time of presentation and after management; The best corrected visual acuity was noted at the end of three months. RESULTS Among our study subjects 45% belonged to the age group of 11-17 years. A male predominance (68.3%) was noted. For most of the subjects, the duration between time of injury and time of examination was less than 6 hours. The proportion of closed globe type of injury (80%) was significantly higher as compared to open globe (8.3%) and extraocular type of injury (11.7%). At the 3 month follow up, out of the 53 study subjects, 92.45% had good visual outcome (VO), 3.77% had fair VO and 3.77% had poor VO respectively. CONCLUSIONS Most of the pediatric ocular trauma may be avoided, which emphasizes the value of health education, adult supervision, and the implementation of suitable interventions to lessen the frequency and severity of trauma. Better visual outcome is expected with a shorter duration between time of injury and time of presentation.

Comparison of Summer Coastal Currents off the East Coast of Korea in 2021 and 2022

This study investigates the variability of coastal currents off the east coast of Korea, specifically in the Wangdolcho area of the East/Japan Sea, from June 2021 to October 2022. The observations revealed significant fluctuations in depth-averaged current velocity, with a peak of 0.81 m/s in August 2021 and a minimum of −0.05 m/s in August 2022. These year-to-year variations highlight the complex dynamics of coastal currents influenced by regional wind patterns and mesoscale eddies. In the summer of 2021, the development of offshore eddies, coupled with variable alongshore wind stress, led to increased current velocities and alternating upwelling and downwelling conditions, resulting in abrupt changes in current intensity. Conversely, in the summer of 2022, the negative vorticity in the Korea Strait and negative wind stress curl along the coast likely caused the East Korean Warm Current to shift further offshore, resulting in a weakened southward flow along the coast. This study emphasizes the need for long-term monitoring to better understand the coastal current dynamics and their environmental impacts. The anticipated completion of the Wangdolcho Ocean Research Station is expected to greatly improve monitoring capabilities, providing continuous and comprehensive data that will enhance our understanding of coastal currents and their broader impacts on the marine environment.

Evaluation of an immersed boundary numerical framework to address the wind field in complex urban topographies

Estimating the wind velocity field in an urban area is important for pedestrian comfort and safety, as the local wind velocities dictate the transport of heat and air pollution in urban environments. Therefore, it is an essential requirement to assess wind patterns when designing urban areas. Computational Fluid Dynamics (CFD) numerical solvers are usually employed to estimate the wind comfort in an urban area under different wind intensities and directions. However, CFD simulations are expensive in terms of time, especially when many scenarios are addressed to ensure safety and comfort for multiple conditions. Here, a CFD framework based on an immersed boundary approach to discretize the urban topography is developed and validated against experimental data in a wind tunnel and two different standard body-fitted mesh codes. The new solver employs a structured cartesian octree grid automatically generated from Lidar data of urban topographies. The advantages are eliminating the complex and time-consuming pre-processing of urban topographies and making the framework accessible to urban planners without CFD expertise. Furthermore, the code is equipped with GPU parallelization that further reduces the computational time. Provided that the best practice guidelines for urban simulations are satisfied, in particular at least 10 cells between two buildings, the code shows very good agreement in all the tests comprising of a simplified and real urban neighborhood highlighting the importance of accurately solving the complex terrain topography of an urban region when non-negligible elevation changes of the order of 20/40 meters are present.

Focal Point Technology: Controlling Treatment Depth and Pattern of Skin Injury by a Novel Highly Focused Laser.

Selective Photothermolysis has limitations in efficacy and safety for dermal targets. We describe a novel concept using scanned focused laser microbeams for precise control of dermal depth and pattern of injury, using a 1550 nm laser that generates an array of conical thermal zones (CTZ) while minimizing injury to the epidermis. To characterize the CTZs in-vivo and determine safe starting parameters to transition to a second phase to explore potential clinical indications. A focused toroidal (ring) laser beam was delivered through a cold sapphire window, sparing epidermal injury in a central zone. Pulse energy, lesion depth, density and energy delivery were titrated in ex-vivo human skin, and subsequently on the backs of 21 human subjects. Histology showed microscale patterns of thermal injury which varied predictably with laser parameters. Time course healing through histology and skin surface imaging demonstrated the ability of the device to deliver high energies without sequelae. Clinical data is currently being collected to further explore safety and efficacy of the device. The 1550nm laser with focal point technology enables precise control of lesion depth while simultaneously sparing a large portion of the epidermis, lowering the risk of adverse effects.

Differences in Injury Patterns and Delays in Care-Seeking Behaviors in the Anabaptist Population

BACKGROUND: The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery. OBJECTIVE: To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin. METHODS: This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist. RESULTS: A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p < .01) and an activation of Pediatric Level I (OR 4.07, p < .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p < .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p < .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p < .01), near drowning (OR 14.09, p < .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01). CONCLUSIONS: This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.

Clinical Patterns and Outcomes of Hospitalized Patients with Grinder-related Neurovascular Injuries: A Decade of Experience from a Level I Trauma Center

BackgroundOccupational injuries impose a substantial global burden, affecting millions of workers annually, which demands urgent attention to enhance workplace safety and health standards. We aimed to outline the frequency, patterns of injury, and clinical characteristics of patients injured by high-rotation cutting tools (grinders) and to pinpoint the neurovascular (nerves and blood vessels) injuries. MethodsA retrospective study was conducted and included all adult patients hospitalized because of grinder-related injuries (GRIs) at the only level I Trauma Center in the country. The characteristics of patients, mechanism of injury, management and outcomes were analyzed based on the anatomical location of injuries. Results127 patients were hospitalized with GRIs over ten years. The incidence of GRIs showed an increasing trend over the years. All patients were males with a mean (SD) age of 34.9 (9.8) years. The majority were general laborers (66.1%), injured by portable grinders (86.6%), and direct blade contact (64.6%). The median Injury Severity Score (ISS) was 5.0(IQR 4.0-9.0), and the median Glasgow Coma Scale (GCS) at ED was 15 (3-15). The most frequently injured part was the upper extremity (36.2%), followed by the lower extremity (33.9%) and the face (27.6%). One-third of cases had vascular injuries, and 23.6% had nerve injuries. Suturing was done for all patients; repairs and debridements were performed in 62% and 58% of cases, respectively, and 21% required vascular surgery. Amputations were required in 9.4% of cases. Thirty patients had nerve injuries involving the median (11%) and radial (9.4%) nerves. Among patients who had neurovascular injuries, 30% (12/40) experienced complications during the hospital stay, while 60% (24/40) ended up with physical disabilities. ConclusionIndividuals affected by power-tool accidents were predominantly young males, mainly general laborers, with a significant proportion being expatriates. The trend of grinder-related injuries increases over time, with portable grinders being a primary source of injuries due to direct contact with the blade. The anatomical injuries mainly include fractures of the upper and lower extremities. Further studies are warranted to understand the cultural aspects and training requirements of workers handling power tools, aiming to achieve sustainable injury prevention effectively.

Understanding the mechanism of injury and fracture pattern of paediatric triplane ankle fractures versus adult trimalleolar fractures.

Paediatric triplane fractures and adult trimalleolar ankle fractures both arise from a supination external rotation injury. By relating the experience of adult to paediatric fractures, clarification has been sought on the sequence of injury, ligament involvement, and fracture pattern of triplane fractures. This study explores the similarities between triplane and trimalleolar fractures for each stage of the Lauge-Hansen classification, with the aim of aiding reduction and fixation techniques. Imaging data of 83 paediatric patients with triplane fractures and 100 adult patients with trimalleolar fractures were collected, and their fracture morphology was compared using fracture maps. Visual fracture maps were assessed, classified, and compared with each other, to establish the progression of injury according to the Lauge-Hansen classification. Four stages of injury in triplane fractures, resembling the adult supination external rotation Lauge-Hansen stages, were observed. Stage I consists of rupture of the anterior syndesmosis or small avulsion of the anterolateral tibia in trimalleolar fractures, and the avulsion of a larger Tillaux fragment in triplanes. Stage II is defined as oblique fracturing of the fibula at the level of the syndesmosis, present in all trimalleolar fractures and in 30% (25/83) of triplane fractures. Stage III is the fracturing of the posterior malleolus. In trimalleolar fractures, the different Haraguchi types can be discerned. In triplane fractures, the delineation of the posterior fragment has a wave-like shape, which is part of the characteristic Y-pattern of triplane fractures, originating from the Tillaux fragment. Stage IV represents a fracture of the medial malleolus, which is highly variable in both the trimalleolar and triplane fractures. The paediatric triplane and adult trimalleolar fractures share common features according to the Lauge-Hansen classification. This highlights that the adolescent injury arises from a combination of ligament traction and a growth plate in the process of closing. With this knowledge, a specific sequence of reduction and optimal screw positions are recommended.

Shifting to an app-based method of preoperative templating in orthopaedic surgery.

Preoperative templating plays an important part in attaining successful surgical outcomes after fracture fixation. Traditionally, surgeons have performed this task with printed radiographs, tracing paper, and colored markers. Now that digital radiography is ubiquitous, and digital templating platforms are needed but are expensive and may not be available to all surgeons, especially those in low-income and middle-income countries. In this study, we evaluate an innovative and user-friendly method using a mobile app that may facilitate the use of digital templating for all surgeons worldwide. A study involving 2 groups of residents (N = 12) was conducted. Group A (n = 6) was assigned to do conventional templating; Group B (n = 6) was assigned to perform digital templating. Each group then switched to the other templating method and the process was repeated. Conventional templates were evaluated using the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation (AO-ASIF) guidelines of template completeness. Digital templates were assessed using Image-Based Surgery Planning. Each subject in both groups completed templates for 3 injury patterns: AO 2R2A3/2U2C2, 32B2, and 43C2. Wilcoxon signed-rank and binomial tests (5% level of significance) were used for statistical analysis. Template processing, fracture classification, and plan elaboration were comparable between the traditional and digital template groups, with good interobserver and intraobserver reproducibility using the Wilcoxon signed-ranks test (all |z values| below 1.96, all P-values > 0.05). There was no significant difference in the evaluation scores for either exercise, whether doing a traditional standard template or the digital template (P value > 0.05). This study shows that digital templating can achieve the same goals as conventional preoperative templating for fracture fixation. With the ubiquity of digital radiography, digital templating provides an opportunity to visualize fracture configurations and create an optimum preoperative plan for fracture reconstruction using an innovative and user-friendly platform.

Reverse Essex-Lopresti and Other Forms of Longitudinal Forearm Instability.

Longitudinal forearm instability is a consequence of interosseous ligament complex disruption. Radiographic identifiers should alert the surgeon to the disrupted structures. Understanding the injury pattern can simplify the treatment process. The clinical presentation will vary based on the involved interosseous ligament components. The surgeon should aim to restore the anatomic radioulnar relationship and then address the remaining pathology as needed. The central band is the foundational structure that maintains this relationship and should be addressed in each injury pattern when disrupted. In this study, we describe rare forms of longitudinal forearm instability.

The Essex-Lopresti Injury.

The classic Essex-Lopresti injury (ELI) pattern is a radial head fracture and disruption of the central band, which compromises the longitudinal radioulnar relationship. Delayed recognition and inappropriate treatment of ELI can be devasting to a patient's function. The recent literature has demonstrated an improved understanding of the mechanism of ELI. This has facilitated early diagnosis, appropriate treatment, and compelling outcomes. Further investigation will contribute to the standardization of treatment methods and algorithms for concomitant injury.

Changing trends in injury patterns of undocumented migrants along the Hungarian–Serbian border from 2018 to 2022

ObjectiveThe Traumatology Clinic of the University of Szeged is a level one Trauma center situated near the Hungarian - Serbian border, where a 4 m tall fence constructed in 2018 serves as a barricade leading to numerous trauma cases. The objective of this study is to characterize the epidemiology of injuries, challenges, and recent trends whilst treating these undocumented migrants in Hungary. Materials and methodsA national retrospective mono-centrical study was performed, examining 982 patients who were admitted to the emergency trauma center in the University of Szeged between January 2018 and December 2022, using data from our electronic administrative system (eMedSol). Factors such as basic epidemiology, country of origin, fractures- according to the AO classification- and its respective treatments, mechanism of injury, duration of stay, and costs were assessed to set as a basis for prediction using a regression model. ResultsA total of 982 patients from 2018 to 2022 were included in the study. Patterns of injury included calcaneal fractures in 2018 and 2019 whereas in 2021 and 2022 along with the exponential increase in patient number, bilateral calcaneal fractures, open and multi-fragmentary tibial fractures were also observed. Additionally, seasonal variations, favoring the months of September through November were observed. Treatment cost ratios, especially surgeries, have also been consistent with the pattern of proximalizing injuries; more proximal surgeries indicate higher surgical costs which is evidently visible in the significantly higher cost ratio dedicated to surgery in 2022. ConclusionWhile migration seems to be a global problem affecting governments and citizens alike, rarely do we understand the direct consequences of illegal migration affecting healthcare services. Hungary in particular created a 4 m tall wall between Serbia in 2019 with means of preventing illegal migration, which in turn led to gradual and later an exponential increase in the number of injured patients particularly in the years 2021 and 2022. Undocumented migrant cases have increased exponentially between 2018 and 2022, with certain patterns seen not only in the injury types but also in seasonal variations and cost expectations. Injuries have been showing a trend of proximalization and have been of more serious quality, including bilateral and/or open injuries. Revisions after surgery were virtually impossible due to the discharging of patients back to border control after their definitive treatment. The need for adequate quality surgical care, manpower and financial aid should be considered.