Presence Of Concomitant Injuries Research Articles

RR30. Long-term Clinical Outcome and Functional Status after Arterial Reconstruction in Upper Extremity Injury

To analyze long-term outcome including functional status in patients after arterial repair of civilian upper limb injury in our institution. This was a retrospective data analysis. All consecutive patients who had undergone repair of arterial lesions in the upper limb during the past two decades in our institution were included. Patients′ records were reviewed for demographic parameters, mechanism of injury, location of arterial lesion, presence of concomitant injuries (nerve, bone, and/or joint), and details of arterial repair. Clinical follow-up studies were performed. End points were long-term patency and long-term functional status using the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH). A total of 117 arterial repairs were performed in 108 patients (87 male; median age, 35.7 years). Blunt trauma was the predominant cause of injury (n = 96 [82%]). Accompanying lesions of nerves (n = 39 [36%]) and/or orthopedic injuries (n = 65 [60%]) were present in 84 patients (78%). After a median follow-up time of 5.3 years (range, 0.5-19.7 years), 65 patients (60% of 108) were re-investigated. Long-term patency was 97%. Significant long-term functional impairment, as measured by the DASH questionnaire, was frequently seen, and determined by concomitant neurologic injury (DASH scores with neurologic lesion: 43.2 ± 31.4 vs without: 10.2 ± 21.1; P < .001) and ischemia at time of injury (DASH scores with ischemia: 31.4 ± 34.4 vs no ischemia: 14.4 ± 22.4; P < .05). Patients with injuries to the subclavian or axillary artery had higher disability than patients with brachial or forearm arterial injuries. On the other hand, DASH scores were independent of gender, age, and side of injury. Excellent long-term patency rates after arterial repair in upper extremity injuries can be achieved. Long-term functional impairment is a significant problem and determined by the associated neurologic injury as well as ischemia present at time of injury.

RR31. The Value of Digital Subtraction Venography in Patients With Advanced Chronic Venous Insufficiency Is Improved by Trial Ballooning

Methods: This was a retrospective data analysis. All consecutive patients who had undergone repair of arterial lesions in the upper limb during the past two decades in our institution were included. Patients0 records were reviewed for demographic parameters, mechanism of injury, location of arterial lesion, presence of concomitant injuries (nerve, bone, and/or joint), and details of arterial repair. Clinical follow-up studies were performed. End points were long-term patency and long-term functional status using the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH). Results: A total of 117 arterial repairs were performed in 108 patients (87 male; median age, 35.7 years). Blunt trauma was the predominant cause of injury (n 1⁄4 96 [82%]). Accompanying lesions of nerves (n 1⁄4 39 [36%]) and/or orthopedic injuries (n 1⁄4 65 [60%]) were present in 84 patients (78%). After a median follow-up time of 5.3 years (range, 0.5-19.7 years), 65 patients (60% of 108) were re-investigated. Long-term patency was 97%. Significant long-term functional impairment, as measured by the DASH questionnaire, was frequently seen, and determined by concomitant neurologic injury (DASH scores with neurologic lesion: 43.2 6 31.4 vs without: 10.2 6 21.1; P < .001) and ischemia at time of injury (DASH scores with ischemia: 31.4 6 34.4 vs no ischemia: 14.4 6 22.4; P < .05). Patients with injuries to the subclavian or axillary artery had higher disability than patients with brachial or forearm arterial injuries. On the other hand, DASH scores were independent of gender, age, and side of injury. Conclusions: Excellent long-term patency rates after arterial repair in upper extremity injuries can be achieved. Long-term functional impairment is a significant problem and determined by the associated neurologic injury as well as ischemia present at time of injury.

Is age of the patient an independent predictor influencing the management of cranio-maxillo-facial trauma? A retrospective study of 308 patients

To determine whether patient age is an independent predictor of indication for surgical treatment, realization of surgical procedure, and care management modality. We analyzed data of 308 patients with facial fractures. Patients were classified into four age groups: (1) 17 to 40 years old; (2) 41 to 64 years old; (3) 65 to 80 years old; (4) more than 81 years old. Multivariate analysis showed that the patient's age was associated with decreased indication and realization rate for surgery (P = .03 in Group 3; P = .05 in Group 4) and with an increased hospitalization rate (P = .004 in Group 3; P = .02 in Group 4). The presence of concomitant injuries and the fracture's location were associated with a decreased indication and realization rate for surgery regardless age. The current study demonstrated that the patient's age was an independent predictor influencing the treatment decision and realization process as well as the care management modality.

Профилактика и лечение осложнений у больных с позвоночно-спинномозговой травмой (часть 1)

The various types of complications at patients with spinal trauma are described. The data concerning etiology, pathogenesis, clinical signs of complications related to course of traumatic disease of spinal cord are presented. The pyoinflammatory and vascular complications in pre-and postoperative periods as well as the data concerning the features of microflora at patients with spinal trauma are listed. The periods of various complications development are presented in relation to severity of spinal cord trauma, presence of concomitant injury as well as to trauma periods and surgical treatment. The prevention measures for avoiding complications in pre-and postoperative periods are presented. The technical complications of operative interventions on vertebral column and spinal cord connected with surgical approaches, implants placement, performance of corporectome and/or laminectomy for all vertebral levels are described in details. The data concerning various delayed complications in postoperative period because of spondylodesis failure as well as fracture and dislocation of fixators are also described.

Unfolding the hidden facts of paediatric maxillofacial trauma.

Hard tissue injuries are uncommon in the paediatric patient; the paediatric population sustains 1 to 14.7% of all facial fractures. The management of the paediatric patient with maxillofacial injury should take into consideration, the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development and the specific injuries and anatomic sites that the injuries affect. Minimally displaced fractures in paediatric patients can be managed conservatively, while displaced fractures may require open approaches and rigid fixation. Hence, the present article presents an overview of the available published literature on maxillofacial trauma in paediatric patient.

Surgical Management of Pediatric Radial Neck Fractures

Management of pediatric radial neck fractures is controversial regarding acceptable alignment, variable reduction techniques, and suboptimal outcomes. The purpose of this study was to assess the characteristics, management, and results in a surgical cohort, in efforts to identify prognostic factors and offer treatment suggestions. It was hypothesized that less invasive reduction maneuvers would precede open reduction and that worse results would correlate with fracture severity, open reduction, and the presence of associated injuries. Retrospective analysis of 151 children in whom a radial neck fracture had been surgically treated from 2001 to 2011 was performed. The mean age (and standard deviation) and duration of follow-up were 8.4 ± 2.9 years and 13.3 ± 20.0 months, respectively; 40% of the patients were male. A successful clinical result was defined as elbow flexion of ≥120°, flexion contracture of <20°, forearm rotation of ≥90° with ≥45° of supination and pronation, and no complications. An isolated radial neck fracture occurred in 54% of the children. The mean angulation and displacement improved from 43° ± 19° and 37% ± 35%, respectively, before treatment to 13° ± 7° and 0.9% ± 4% after treatment (p < 0.001). Twenty-two procedural combinations were used to treat these patients, and 67% of the open reductions were not preceded by percutaneous or closed reduction attempts. Among 131 patients with adequate follow-up, 31% had an unsuccessful outcome. An age of ten years or more (odds ratio [OR] = 5.85, p = 0.001), a time to surgery of two days or less (OR = 4.73, p = 0.02), and greater fracture displacement (OR = 1.25 per 10%, p = 0.001) were independent predictors of unsuccessful outcomes. Increased fracture severity and open reduction were associated with poor results, although the presence of concomitant injuries was not. It is predicted that closed manipulation will fail for half of fractures angulated ≥36°, and that half of fractures displaced ≥65% will require open reduction. The predicted frequency of unsuccessful outcomes is 50% with 76% displacement. There continues to be great variation in the approach to treatment of displaced radial neck fractures in children. Suboptimal results occurred in 31% of the patients in this series, with worse results in patients older than ten years, who had increased fracture severity, and who underwent open reduction. Less invasive reduction methods should precede open reduction whenever possible.

Epidemiology of Facial Fracture Injuries

Injuries resulting from accidents are a leading cause of mortality and morbidity. The objective of this study was to present epidemiologic estimates of hospital-based emergency department (ED) visits for facial fractures in the United States. The Nationwide Emergency Department Sample for 2007 was used. All ED visits with facial fractures were selected. Demographic characteristics of these ED visits, causes of injuries, presence of concomitant injuries, and resource use in hospitals were examined. All estimates were projected to national levels and each ED visit was the unit of analysis. During 2007 in the United States, 407,167 ED visits concerned a facial fracture. Patients' average age for each ED visit was 37.9 years. Sixty-eight percent of all ED visits concerned male patients, and 85,759 ED visits resulted in further treatment in the same hospital. Three hundred fourteen patients died in EDs, and 2,717 died during hospitalization. Mean charge per each ED visit was $3,192. Total United States ED charges were close to $1 billion. Mean hospitalization charges (ED and inpatient charges) amounted to $62,414. Mean length of stay was 6.23 days, and total hospitalization time in the entire United States was 534,322 days. Frequently reported causes of injuries included assaults (37% of all ED visits), falls (24.6%), and motor vehicle accidents (12.1%). The management of maxillofacial fractures in EDs across the United States uses considerable resources. The public health impact of facial fractures is highlighted in the present study.

Maxillofacial Injuries in the Pediatric Patient: An Overview

ABSTRACT Children are uniquely susceptible to craniofacial trauma because of their greater cranial mass-to-body ratio. The pediatric population sustains 1 to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7-80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4-88%). The management of the pediatric patient with maxillofacial injury should take into consideration, the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic and psychological), and the specific injuries and anatomic sites that the injuries affect. The greatest concern when treating the pediatric patient is the effect of the injury or treatment on growth and development. This is both anatomically and psychologically important and may have various effects on management for the different stages of psychological development.

Association of Knee Bone Bruise Frequency with Time Postinjury and Type of Soft Tissue Injury

This study correlated the frequency of bone bruises with soft tissue injuries in the knee and examined bruise frequency as a function of time postinjury. Magnetic resonance imaging of 1546 patients revealed bone bruises in 19% of patients without an associated meniscal or ligamentous injury. For those patients presenting with at least one meniscoligamentous injury, the frequency of bruising was 60% at 0 to 4 weeks, 42% at 4 to 10 weeks, and 31% at 10 to 26 weeks postinjury. The frequency of bruising varied with the presence of concomitant injuries, with the greatest frequency of bruises (78%) observed in patients with anterior cruciate ligament injuries.

Association of Knee Bone Bruise Frequency with Time Postinjury and Type of Soft Tissue Injury

This study correlated the frequency of bone bruises with soft tissue injuries in the knee and examined bruise frequency as a function of time postinjury. Magnetic resonance imaging of 1546 patients revealed bone bruises in 19% of patients without an associated meniscal or ligamentous injury. For those patients presenting with at least one meniscoligamentous injury, the frequency of bruising was 60% at 0 to 4 weeks, 42% at 4 to 10 weeks, and 31% at 10 to 26 weeks postinjury. The frequency of bruising varied with the presence of concomitant injuries, with the greatest frequency of bruises (78%) observed in patients with anterior cruciate ligament injuries.

MOC-PS(SM) CME Article: Treatment of Flexor Tendon Laceration

After studying this article, the participant should be able to: 1. Understand the preoperative assessment of the patient who presents with a flexor tendon laceration. 2. Understand the surgical options for flexor tendon lacerations based on location, type, and presence of concomitant injuries. 3. Understand the appropriate postsurgical treatment and therapy. 4. Understand the expected outcomes of operative repair and potential complications. Flexor tendon laceration is one of the injuries most commonly encountered by the hand surgeon. Appropriate workup, treatment, and postsurgical therapy are essential to achieving favorable outcomes. The current literature on each aspect of acute flexor tendon injury diagnosis and repair was reviewed. A systematic approach to the evaluation and treatment of flexor tendon lacerations should adhere to basic principles of hand surgery with the intention of minimizing complications and offering patients the greatest chance of functional recovery.

Luxation radio-carpienne: À propos d’une série de 12 cas et revue de la literature

Purpose of the study Radiocarpal dislocation is an uncommon entity in traumatology. Proper management depends on the type of dislocation and the presence of concomitant injury. The purpose of this study was to detail the pathogenesis of radiocarpal dislocation and describe its complications and treatment. Material and methods Twelve radiocarpal dislocations were reviewed retrospectively. Nine were associated with multiple trauma. For this review, physical examination was performed to determine the functional status, presence of pain, joint motion, and grip force. The Green and O’Brien score as modified by Cooney was used to assess function. Grip force was measured with a Jamar dynamometer and weighted by the non-dominant/dominant ratio. Dumontier and Moneim classifications were used to define different types of radiocarpal dislocation. Radiological evaluation was based on anteroposterior (ulnar and radial inclination) and lateral views of the wrist. Results Dorsal displacement was observed for nine dislocations. All were associated with fractures (eleven fractures of the lateral cuneal process and eight fractures of the styloid process). Other associated injuries were distal radioulnar dislocation and intracarpal sprains (two scapholunate and two lunotriquetral). There were three median nerve compressions which all regressed without sequelae. Ten patients were treated by styloradial osteosynthesis alone and two patients by capsule-ligament suture via an anterior approach. Pinning was used to stabilize the two lunotriquetral injuries and the one neglected radioulnar dislocation. Results At last follow-up (mean 46.2 months), the overall functional outcome was satisfactory. The Green and O’Brien (modified by Cooney) score was excellent for one patient, fair for eight, and mediocre for three (75% satisfactory results). Distal radioulnar degeneration developed in the patient who had a neglected radioulnar dislocation. Three cases of radiocarpal degeneration were observed in patients with neglected scapholunate sprains whose wrist was symptomatic at last follow-up. Discussion Radiocarpal dislocation is associated with intracarpal fracture and/or injury. Intracarpal injury must be treated in order to limit the risk of future degeneration. Pure radiocarpal dislocation (or in association with a minimal fracture of the styloid) should be treated surgically, irrespective of the approach, in order to achieve capsule-ligament suture. Other radiocarpal dislocations can be simply reduced with osteosynthesis of associated fractures. Intracarpal and/or distal radioulnar lesions must be stabilized. Osteosynthesis or capsule-ligament suture must be achieved to obtain a satisfactory clinical result.

Maxillofacial injuries in the pediatric patient.

Approximately 22 million children are injured in the United States annually. Children are uniquely susceptible to craniofacial trauma because of their greater cranial-mass-to-body ratio. The pediatric population sustains 1% to 14.7% of all facial fractures. The majority of these injuries are encountered by boys (53.7% - 80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4% - 88%). The management of the pediatric patient with maxillofacial injury should take into consideration the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic, and psychologic), and the specific injuries and anatomic sites that the injuries affect. This comprehensive review, based on the last 25 years of the world's English-speaking surgical literature, presents current thoughts on the anatomic and physiologic differences between adults and children, a synopsis of childhood growth and development, and an overview of state-of-the-art management of the pediatric patient who has sustained maxillofacial injury.

Evolution in the management of the complex liver injury at a Level I trauma center.

Management of the severe liver injury evolved from mandatory surgical repair to a more selective approach. This paper reviews the changes in management of the severe liver injury at a Level I trauma center. We reviewed the records of patients with severe liver injury admitted to a Level I trauma center between January 1984 and December 1995. The patients were divided into two groups, G1 and G2, based on their date of admission before or after January 1991. The two groups were compared for blood products use, management of the liver injury, and outcome. One hundred six patients were compared for age, sex, Acute Physiology and Chronic Health Evaluation II score, Injury Severity Score, abdominal Abbreviated Injury Scale score, and the presence of concomitant injuries. There was no difference in management or outcome of the victims of penetrating injury between G1 and G2 (n = 48). The blunt injury patients in G1 (n = 22) had more liver surgery (p = 0.006), blood transfusion (p = 0.040), intra-abdominal sepsis (6 vs. 0), and higher mortality (p = 0.041) than those in G2 (n = 36). Isolated severe blunt liver injury may be managed nonoperatively with better survival and less blood products use.