Motor Vehicle-pedestrian Accidents Research Articles

Obesity as a Risk Factor for Adverse Outcomes After Pedestrian Trauma Accidents in the Pediatric Population.

The aim of the study is to determine whether overweight or obese children are at an increased risk for injury and adverse outcomes following pedestrian motor vehicle accidents. We performed a retrospective study of patients between the ages of 2 and 17 who were pedestrians injured in a collision with a motorized vehicle, presenting to a level 1 trauma center, between January 1, 2010, to December 31, 2021. Patients with admission weights falling above the 90th percentile of the Centers for Disease Control and Prevention's sex-specific growth charts were identified as overweight/obese, those below the cutoff were categorized as nonobese. Groups were compared regarding demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale by body region of injury. Outcome measures included hospital admission, length of hospital stay, intensive care unit (ICU) admission, ICU length of stay, and mortality. Of the 306 patients included, 72 (23.5%) were overweight/obese and 234 (76.5%) were nonobese. The mean Injury Severity Score scores were higher among overweight/obese patients (5.37 vs 8.74, P = 0.008). Overweight/obese children were more likely to sustain severe abdominal injuries (Abbreviated Injury Scale ≥ 3) (12.2% vs 5.1%; odds ratio [OR], 2.64; 95% CI, 1.07-6.56; P = 0.030), be admitted to the hospital (94.5% vs 74.3%; OR, 12.07; 95% CI, 2.87-50.72; P < 0.001), require ICU admission (31.0% vs 20.0%, OR, 1.87; 95% CI, 1.03-3.36; P = 0.036), and require a longer ICU stay (0.9 vs 0.4 days, P = 0.014) compared with nonobese patients. Obese and overweight children are at increased risk for higher injury severity scores, severe abdominal injuries, and ICU admission after pedestrian motor vehicle accidents.

Epidemiology of head injuries in pedestrian-motor vehicle accidents

Despite efforts of many countries to improve pedestrian safety, international reports show an upward trend in pedestrian-motor vehicle accidents. Although the most common cause of death of pedestrians is head injuries, there is a lack of knowledge on the epidemiology and characteristics of head injury in terms of the Glasgow Outcome Scale to be used for prevention. However, this study aimed to determine the epidemiology of pedestrian-motor vehicle accidents, the characteristics of head injury, and differences in the Glasgow Outcome Scale in terms of gender. In this retrospective analytical study, the data of 917 eligible injured pedestrians were obtained from the two databases of the Trauma System and the Hospital Information System. The data were analyzed using SPSS software (Version 21). The mean age of all 917 injured pedestrians was 47.55 ± 19.47 years. Most of the injured pedestrians (42.10%) were in the age range of 41–69 years and 81.31% were male. Moreover, 83.07% did not have any acute lesions on the CT scan. The most common brain lesion was brain contusion (n = 33, 3.60%), subarachnoid hemorrhage (n = 33, 3.60%), and skull fracture (n = 29, 3.16%). Among all concurrent injuries, lower extremity/pelvic injuries were observed in 216 patients (23.56%). Outpatient treatment (n = 782, 85.27%), airway control/endotracheal intubation (n = 57, 6.22%), and resuscitation (n = 35, 3.82%) were the most applied treatments respectively. There were significant differences in the Glasgow Outcome Scale between men and women (P- value = 0. 012). The high rate of mortalities, disability, head injuries, contusion, subarachnoid hemorrhage, and skull fractures in pedestrians involved in MVAs emphasizes the need for developing and implementing prevention strategies including appropriate management and risk reduction. Male pedestrians were at higher risk of motor vehicle accidents and worse Glasgow Outcome Scale. The presented data identified the main types of pedestrian injuries and suggested the importance of adopting appropriate preventive strategies to achieve the most effective interventions for creating a safer community.

Analysis of pedestrian accident injury-severities at road junctions and crossings using an advanced random parameter modelling framework: The case of Scotland

This paper investigates the determinants of injury severities in pedestrian-motor vehicle accidents at signalised and unsignalised junctions, and at physically-controlled and human-controlled crossings in Scotland. The accident data were drawn from the official police crash report database of the UK spanning a period between 2010 and 2018. Correlated random parameter ordered probit models with heterogeneity in the means were developed in order to account for the multi-layered impact of unobserved heterogeneity on statistical estimation. The model estimation results showed that the severities of accident injuries are affected by roadway, location, weather, vehicle, and driver characteristics as well as temporal attributes (including time and day of the accident). Factors such as the urban context, lighting and weather conditions and road surface conditions were found to result in correlated random parameters, thus capturing the intricate, yet interactive effects of unobserved heterogeneity, and particularly the unobserved behavioural response of road users to different traffic control types at junctions and crossings. Vehicle type, driver’s gender and day-of-the-week were observed to influence the random parameters' distributions. Empirically, the results showcase variations in the determinants of injury severities at signalised and unsignalised junctions, and at physically-controlled and human-controlled crossings. Even though most of these variations were related to the magnitude of impact of the determinants, differences in the directional effects on injury severities were also identified, mainly for factors related to weather conditions, hazard presence on the road, and temporal characteristics of the accidents.

MON-336 Presumed Parathyroid Infarction Leading to Remission of Primary Hyperparathyroidism: A Rare Clinical Occurrence

Background: Infarction of a parathyroid adenoma, also known as ‘parathyroid auto-infarction’ or ‘parathyroid apoplexy,’ is a rare condition that can present and lead to acute and dramatic reduction of calcium (Ca2+) and parathyroid hormone (PTH) levels and spontaneous remission of primary hyperparathyroidism (PHPT). Some patients may experience neck pain, dysphagia, hoarseness, anterior neck swelling or ecchymoses, while others are asymptomatic. Ultrasound can show the lesion getting larger due to hemorrhage, but weeks to months later, there can be a size decrease of the adenoma due to loss of blood supply and necrosis. Sestamibi scans can also show non-localization on serial exams. Few case reports have evidence of infarction on pathology.Clinical Case: A 38 year old man with no significant past medical history presented after a pedestrian-motor vehicle accident with polytrauma, including a cervical spine injury requiring tracheostomy and immobilization of his neck. Over the first week of his hospitalization, his Ca2+ rose as high as 14.0 mg/dL (8.9-10.2 mg/dL). Concurrent PTH level was 233 pg/mL (12-88 pg/mL) and 25-OH vitamin D level was 14.8 ng/mL (20.1-50.0 ng/mL). A neck ultrasound showed a hypoechoic nodule measuring 1.4 x 1.2 x 1.6 cm posterior to the superior aspect right thyroid lobe. A sestamibi scan with SPECT-CT showed a persistent focal activity in the region of right thyroid bed. He was treated with aggressive intravenous (IV) hydration, 7 doses of intranasal calcitonin 500 units, multiple doses of furosemide 40-80 mg IV, pamidronic acid 90 mg IV, and eventually transitioned to cinacalcet 30 mg twice daily. Due to his C-spine injury, parathyroid surgery was deferred.Four months later, the patient developed acute muscle spasms. He denied anterior neck pain, dysphagia, bruising, or swelling. Ca2+ level was checked and found to be 7.0 mg/dL. Cinacalcet was decreased, and eventually had to be discontinued. His serial Ca2+ and PTH levels normalized to 9.8 mg/dL and 55 pg/mL, respectively. A repeat 25-OH vitamin D level was replete at 31.1 ng/mL. A follow up ultrasound redemonstrated a slightly ill-defined hypoechoic nodule, now only measuring 0.9 x 0.9 x 1.4 cm along the the right thyroid. A sestamibi scan was also obtained and did not localize any lesion.The biochemical and imaging findings were most consistent with a parathyroid infarction resulting in spontaneous remission of PHPT. Now one year following his initial presentation, he remains normocalcemic.Clinical Lesson: The differential diagnosis for a sudden remission of PTH-dependent hypercalcemia is limited. Parathyroid infarction is a rare condition with paucity of data regarding follow up, but these patients likely need to remain under close long term clinical and biochemical surveillance as recurrence has been documented in the literature.

Prevalence and factors associated with pedestrian fatalities and serious injuries: case Finland

The aim of the study was to examine the prevalence of pedestrian fatalities and serious injuries (MAIS3+) in traffic, and to identify differences in the factors associated with the injury severities. The study included all motor vehicle-pedestrian accidents in Finland in 2014–2017 and exposure data from the national travel survey of 2016. The results showed a heightened fatality and serious injury rate specifically for pedestrians aged over 75 years and in rural heartland areas. Furthermore, differences were identified in the current speed limit, municipality type, lighting conditions, vehicle type, area type, accident location, and road conditions between pedestrian fatalities and serious injuries. The main implications of the study are that traffic safety measures should be tailored to local conditions and amended and redirected to account for both fatalities and serious injuries. In order to conduct comparative studies between countries and support the achievement of transport policy objectives, further harmonisation of definitions and data collection procedures for traffic accidents is needed.

Developing an Adjunct to an Electronic Medical Records System in a Developing Country: Establishing the First Electronic Traumatic Brain Injury Database in Yangon, Myanmar

Abstract INTRODUCTION Traumatic brain injury (TBI) is a frequent cause of admission and fatality in Myanmar, secondary to a high number of road traffic accidents. In a country of over 50 million, trauma centers serve less than 4% of the population. North Okkalappa General Hospital (NOGH) is 1 of 3 trauma centers in Yangon providing significant care for patients with TBI. In this pilot study, we collected prospective data encompassing patient demographics, nature of injury, intervention, and outcome at a tertiary trauma center (NOGH). METHODS Neurosurgery residents utilized an iPad-driven database management online software (Redcap) to document TBI admissions, treatment, and outcomes prospectively between November 2018 and April 2019. The data was monitored and analyzed weekly by the supervising physicians at the Henry Ford Hospital in Detroit, Michigan. RESULTS There were 242 TBI admissions (mean Glasgow Coma Scale (GCS) 12.97) during the study's timeline. Etiologies consisted of motorcycle accidents (n = 130), falls (n = 45), assaults (n = 39), pedestrian–motor vehicle accidents (n = 21), industrial accidents (n = 7), and other (n = 7). A total of 50 patients presenting with GCS &lt; 8 were admitted directly or transferred to NOGH leading to a mortality rate of 68% during hospitalization. Neurosurgery was performed in 33 patients (14%) with a 24% postoperative mortality rate. CONCLUSION Poor outcomes after severe TBI in Myanmar are multifactorial including a lack of access-to-care, suboptimal patient management (eg, pre-hospital, in-hospital and postoperative) and limited resources (eg, ventilators, arterial lines, etc.). Additionally, critical care expertise is limited. Overall, in this study we were able to establish a robust database in a research and electronic medical records-naïve location, serving to study and characterize TBI patients. Improved TBI care at local and national levels requires public education, efficient transport systems, geographically strategic trauma centers and improved in-hospital patient care. Government funding and international neurosurgery support is essential.

PC194. Follow-up Imaging of Blunt Vertebral Artery Injuries Is Unnecessary

Routine computed tomography (CT) imaging in trauma patients has led to increased recognition of blunt vertebral artery injuries (BVI). We sought to determine the prevalence of strokes, injury progression, and need for intervention in patients with BVI. Consecutive patients presenting with BVI over two years were identified from the institutional trauma registry. Inpatient records, imaging studies and follow-up data were reviewed in detail from the electronic medical record. 76 BVI were identified in 70 patients (64% males, mean age 47 ± 19 years); bilateral injuries occurred in 6 patients. Mechanism of injury included MVC (n = 47), fall (n = 16), pedestrian motor vehicle accident (n = 2), chiropractic manipulation (n = 3), and assault (n = 2). 58 (83%) had associated C-spine fractures. 6 (8.5%) patients had CT or magnetic resonance imaging evidence of posterior circulation infarctions during admission, but only one had residual stroke symptoms after discharge. Minor (grade 1 or 2) injuries occurred in 25 patients (36%), while severe (grade 3 or 4) injuries occurred in 45 (64%). Twelve patients died of associated injuries (8 with severe BVI, 4 with minor BVI, NSD). Of the 58 surviving to discharge, 31 (53%) returned for follow-up CT scans. Six of 10 patients (60%) with minor injuries had resolution or improvement, compared with 3 of 21 patients (14%) with severe injuries (P = .027). One patient (10%) with a minor BVI and two patients (10%) with severe BVI had radiologic progression, but none were clinically significant. During a mean follow-up of 15 ± 13 months, there were no vertebral artery interventions, and there were no delayed strokes (Fig). These data suggest that BVI are relatively benign sequela of cervical trauma. BVI-related strokes present at the time of admission and do not often have clinical sequela. No late strokes occurred in this series, and no interventions were required. The majority of grade 1 and 2 injuries should be expected to improve or resolve. Regardless of severity, these data indicate that follow-up imaging of BVI is not necessary in asymptomatic patients.

Pediatric Motor Vehicle-Pedestrian Accident: a Simulation Scenario for Emergency Medicine Trainees.

Simulation-based medical education is an evolving field that allows trainees to practice skills in a safe environment with no risk to patients. Recently, technology-enhanced simulation for emergency medicine learners has been shown to have favorable effects on learner knowledge and patient outcomes. In this report, a human patient simulator is used to familiarize emergency medicine trainees with the presentation and management of a pediatric motor vehicle-pedestrian accident is described.

Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents.

Background:Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide.Objectives:We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA).Patients and Methods:A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011.Results:Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma.Conclusions:Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.

Traumatic Prefrontal Encephalopathy and Amotivational Apathetic Syndrome: Revisiting the Historical Limitations of Standardized Neuropsychological Assessments

The field of neuropsychology has made significant gains regarding the development and implementation of diagnostic measures and assessment techniques for frontal lobe pathology. Nevertheless, it is becoming increasingly evident that the existing battery of tests remains relatively insensitive to the ever-growing range of functions known to be mediated by the prefrontal regions. In the present study, a 62 year-old gentleman was involved in a pedestrian motor vehicle accident and suffered bilateral prefrontal, left parietal, and left occipital trauma (as evidenced by magnetic resonance imaging (MRI) scans). Secondary to this accident, he complained of significant depression, thought disturbances, and paranoia, while family members reported additional personality changes. A consistent diagnosis of frontal lobe syndrome was established across three independent neuropsychological evaluations, in which his postrehabilitative scores on a range of standardized assessments were consistently above average, regardless of his significant social, affective, and motivational changes following the accident. This case demonstrates the limitations and insensitivity that current standardized measures still obtain for assessing prefrontal lobe injury. The results are interpreted within the context of test development relevant to neuroscience rather than strictly psychometric concerns. The importance of these constraints on the evaluation of frontal lobe syndrome is discussed within the context of traumatic brain injury from contact sports and military combat. For the healthy left frontal lobe, intentional acts involve substantial energy, the desire or intent to engage socially, and the intent to engage in positive affective and verbally interactive activities. These appear to be diminished with the amotivational syndrome arising from dysfunctional left frontal lobe origin and medial frontal pathology with reduced activation of social reward systems and dopaminergic pathways (25, 24). While the patient with left frontal pathology may present with diminished energy and behavioral slowing or inertia, heightened energy or impulsivity may result from right frontal pathology and, by inference, the release of left frontal systems (e.g., decreased caution). Both are described in the scientific literatures as delayed response deficits. However, with left frontal pathology the patient may initiate only following inordinate delays with behavioral slowing or bradykinesia, whereas the patient with right frontal pathology may initiate substantially prior to implementing the organizational planning or caution for successful task completion. Hypoactivity bradykinesia may derive from medial frontal lobe or left frontal lobe pathology and hyperactive or impulsive features with pathology within the homologous regions of the right frontal lobe supplementary motor or orbitofrontal cortex (24, 29). Neuropsychological comprehension of frontal lobe functioning has grown exponentially in scope and research specificity. In the early to mid 1900's, diagnoses of mental illness and abnormal emotionality began to shift towards the implication of dysfunction in specific brain regions. Potential solutions included surgical resection of the brain via frontal lobotomy or lobectomy, which rapidly grew in popularity. German physiologist Friedrich Goltz, in the late 1800's, ablated canine neocortex. Goltz's (23) reporting of character changes in his subjects influenced Swiss physician Gottlieb Burkhardt to translate this early medical intervention to human patients. Portuguese neurologist Egas Moniz (41) was

Mortalidad por accidentes de tránsito en Bayamo, Cuba 2011

With the objective of describing mortality from traffic accidents in Bayamo, Cuba, in 2011 a review was performed of injured and deceased patients due to traffic accidents, recorded in the Hospital Carlos M. de Céspedes. Of the 1,365 injured patients treated in the emergency room, the predominant groups were individuals aged 25 to 44 years comprising 372 patients (27.3%) and men comprising 1,071 (78.5%). 46 people died, most from the same age group and male. Multiple traumatisms (52.6%) and craniofacial trauma (34.2%) were the predominant injuries. Motor vehicle-pedestrian accidents stood out with a mortality of 26.3%. In conclusion, mortality from traffic accidents predominately occurs in young male adults, whose fatal consequences are due to multiple traumatisms from road accidents.

Analyzing fault and severity in pedestrian–motor vehicle accidents in China

The number of pedestrian–motor vehicle accidents and pedestrian deaths in China surged in recent years. However, a large scale empirical research on pedestrian traffic crashes in China is lacking. In this study, we identify significant risk factors associated with fault and severity in pedestrian–motor vehicle accidents. Risk factors in several different dimensions, including pedestrian, driver, vehicle, road and environmental factors, are considered. We analyze 6967 pedestrian traffic accident reports for the period 2006–2010 in Guangdong Province, China. These data, obtained from the Guangdong Provincial Security Department, are extracted from the Traffic Management Sector-Specific Incident Case Data Report. Pedestrian traffic crashes have a unique inevitability and particular high risk, due to pedestrians’ fragility, slow movement and lack of lighting equipment. The empirical analysis of the present study has the following policy implications. First, traffic crashes in which pedestrians are at fault are more likely to cause serious injuries or death, suggesting that relevant agencies should pay attention to measures that prevent pedestrians from violating traffic rules. Second, both the attention to elderly pedestrians, male and experienced drivers, the penalty to drunk driving, speeding, driving without a driver's license and other violation behaviors should be strengthened. Third, vehicle safety inspections and safety training sessions for truck drivers should be reinforced. Fourth, improving the road conditions and road lighting at night are important measures in reducing the probability of accident casualties. Fifth, specific road safety campaigns in rural areas, and education programs especially for young children and teens should be developed and promoted. Moreover, we reveal a country-specific factor, hukou, which has significant effect on the severity in pedestrian accidents due to the discrepancy in the level of social insurance/security, suggesting that equal social security level among urban and rural people should be set up. In addition, establishing a comprehensive liability distribution system for non-urban areas and roadways will be conducive to both pedestrians’ and drivers’ voluntary compliance with traffic rules.

Bilateral Epidural Hematoma In A Patient With Human Immunodeficiency Virus (HIV) Infection: A Case Report

Intracranial epidural haematomas are almost always secondary to head traumas and usually occur unilaterally. Bilateral intracranial epidural haematomas are rare, but the mortality is very high. In our case, we report a bilateral epidural haematoma in a 32 year old, HIV infected male patient who came to the emergency service with a head trauma because of a motor vehicle-pedestrian accident. The occurrence of bilateral epidural haematoma in an HIV infected patient is a rare condition as a result of head trauma in a lateral direction on one side. As a result of the vasculopathy and coagulopathy, which are complications of HIV infection, the cerebral vessels have a fragile structure that leads to complications that facilitate the development of contralateral intracranial epidural haematoma together.

Diagnostic management strategies for adults and children with minor head injury: a systematic review and an economic evaluation

BACKGROUND Patients with minor head injury [Glasgow Coma Scale (GCS) score 13-15] have a small but important risk of intracranial injury (ICI) that requires early identification and neurosurgical treatment. Diagnostic assessment can use either a clinical decision rule or unstructured assessment of individual clinical features to identify those who are at risk of ICI and in need of computerised tomography (CT) scanning and/or hospital admission. Selective use of CT investigations helps minimise unnecessary radiation exposure and resource use, but can lead to missed opportunities to provide early treatment for ICI.

Causes and distribution of facial fractures in a group of South African children and the value of computed tomography in their assessment

The cases of 107 paediatric patients aged 0–12 years were retrospectively reviewed. The patients presented with facial trauma and both plain radiographs and computed tomography (CT) scans had been ordered. Sixty-five per cent of facial fractures were missed in radiography, but revealed on CT; fractures of the maxilla, the zygoma and the orbit were most frequently missed in radiography. Pedestrian motor vehicle accidents were the most frequent cause of facial fractures (37%), followed by passenger motor vehicle accidents (22%). In contrast with other studies reporting the mandible as the most frequent facial fracture site, the most common fracture sites in this study, in descending order of frequency, were the orbit, the frontal bone and the maxilla.

Fusariumsporodochia on cutaneous wounds

A histopathological review of 24 cases of Fusarium-spp. culture-positive human specimens reveal sporodochia in eight cases, all of which were cutaneous injuries. These included three patients with burn wounds, three patients with ischemic necrosis, one patient who suffered trauma with extensive contamination of the injury with vegetation, and one patient with an ischemic skin graft placed for treatment of a non-healing traumatic leg injury sustained in a motor vehicle-pedestrian accident. Sporodochia consisted of swollen cells giving rise to parallel-oriented hyphae that extended upward above the surface, giving rise to a carpet of conidia on its uppermost aspect. Sporodochia have not been previously reported in humans. The presence of Fusarium sporodochia has implications with respect to infection control, as clinical care practices must be tailored to minimize potential aerolization of conidia, chlamydospores and rare budding cells, with resultant spread of the fungus during surgical manipulation, bandage change or cleaning of cutaneous wounds.

Pelvic fractures management in a teaching hospital in Nigeria

BACKGROUND: Significant external forces are required to fracture a normal pelvis. The forces usually result from rapid deceleration or crushing injuries. Associated injuries are common as the energy is delivered to multiple anatomical sites. AIMS/OBJECTIVE: The aim of this study was to highlight the pattern of presentation of pelvic injuries, causes, types of the pelvic fracture and outcome of the treatment of these injuries in a teaching hospital in a developing country. SETTING: Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. DESIGN: A seven-year retrospective study was done from January 1995 to December 2001. RESULTS: The mean age of the patients at presentation was 35.0+14.8 (SD) with 42 males and 11 females. The mean injury severity score was 20.1. Motor vehicular accident remains the most common cause of pelvic fractures in 37(69.8%) patients, fall from height in 8(15.1%) patients, collapsed walls of dilapidated building in 4(7.6%) patients, motor vehicle pedestrian accident and motorbike pedestrian accidents in 2(3.8%) patients each. The type of pelvic fracture was classified according to Tile. Types A, B, and C were found in 24(45.3%), 17(32.1%), and 12(22.6%) patients respectively. In three patients, the fractures were open. Directly associated injury was diagnosed in 9 patients, these were mainly urogenital system, 2 had bladder injuries, 4 had urethral injuries and 3 had vagina laceration. All the patients were managed without recourse to open operative reduction. The outcome was adjudged excellent, good, fair and poor in 18(34%), 20(37.4%), 9(17%), and 6(11.3%) patients respectively. CONCLUSION: It was concluded that most types of pelvic fractures could be managed with satisfactory results in this environment using the facilities available. KEY WORDS: Pelvis fracture, motor vehicle accidents, falls. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 10-15

Cruciate Injury Patterns in Knee Hyperextension: A Cadaveric Model

Summary: We created an experimental model to evaluate the effects of strain rate on the mechanism of combined cruciate ligament injuries in knee hyperextension. Using straight knee hyperextension to rupture the anterior and posterior cruciates, two strain rates (approximately 100% per second and 5400% per second) were applied to reproduce two clinical injury patterns of the knee: low energy (sporting) and high energy (pedestrian–motor vehicle accident). Ten pairs of fresh-frozen cadaveric knees were injured to 45° of hyperextension. Strain rate sensitivity of the posterior cruciate ligament was shown in this model, with midsubstance tears occuring in specimens tested at a low rate and avulsion “stripping” injuries from the femoral side occuring at a high rate. A variable pattern of anterior cruciate ligament tears at both high and low rates suggests that the specific injury mechanism may also involve other factors including notch morphology. We present a simplified mathematic model used to estimate posterior cruciate ligament strain during knee hyperextension.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 5 (July-August), 1999: pp 489–495

Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors.

Fractures of the femoral shaft in children are caused by major musculoskeletal trauma and result in high direct and indirect medical costs. To date, the American literature has focused on treatment options and outcomes, but the epidemiology of these injuries has been generalized from Scandinavian studies reported in the 1970s and early 1980s. The goals of the current study were (1) to determine the age, gender, and race-specific rates and mechanisms of fractures of the femoral shaft in children in a large United-States-based population and (2) to identify associations between the rates of these fractures and multiple sociodemographic indicators. Such information is vital for preventive efforts. The Hospital Discharge Database of the Maryland Health Services Cost Review Commission for the years 1990 through 1996 was used to obtain demographic data on 1485 cases of acute fracture of the femoral shaft in patients who were less than eighteen years old, and data from the United States Bureau of the Census for the state of Maryland for the year 1990 were used to obtain denominator data. Reliable external-cause data were available from the 1995 and 1996 databases for 472 patients. Small-area analysis was performed at the zip-code level to determine associations between numerous sociodemographic indicators and the rate of femoral shaft fracture. The annual rate of femoral shaft fracture in children was 19.15 per 100,000. With regard to age, there was a bimodal distribution, with peaks at two and seventeen years. Boys had higher rates of fracture than did girls at all ages, and blacks had higher rates than did whites. The primary mechanisms of fracture were age-dependent and included falls, for children less than six years old; motor vehicle-pedestrian accidents, for those six to nine years old; and motor-vehicle accidents, for teenagers. Firearm-related injuries accounted for 15 percent of the fractures among black adolescents. Adverse socioeconomic conditions were significantly associated with higher rates of fracture. The rates and mechanisms of femoral shaft fractures in children depend on age, gender, and race. For children living in the United States today, the epidemiology of these fractures is different than that described in earlier, Scandinavian reports.

Renal adenocarcinoma with tumour thrombi in the inferior vena cava and right atrium in a pedestrian motor vehicle accident fatality: case report and medicolegal implications

Dramatic and unexpected natural disease processes may occasionally be encountered in the course of routine forensic pathology practice. The pathophysiological consequences of these processes may carry profound medicolegal implications which may have a bearing on the liability and culpability of the various parties involved. A pedestrian–vehicular incident involving a 53-year-old woman in whom a renal adenocarcinoma with tumour extension to the inferior vena cava and right atrium was discovered at autopsy is reported. The pathophysiological and biochemical disturbances associated with this tumour are discussed and their possible medicolegal implications evaluated.