Skull Bone Fractures Research Articles

Outcome and its predictors in traumatic brain injury in elderly population: Institutional study from Northern India

Introduction:Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Survival and functional outcome is significantly poor in the elderly population. There is a need to develop better geriatric specific prognostic models and evidence-based geriatric traumatic brain injury management protocols for better treatment, rehabilitation, and prevention.Aims and objectives:To study the frequency, outcome and correlates of traumatic brain injury in elderly patients.Material and Methods:Frequency, outcome and correlates of traumatic brain injury in patients more than 65 years of age admitted in tertiary care hospital were studied in 160 patients admitted between 1st January 2016 and 31st December 2016 (retrospective analysis) and between 1st January 2017 and 30th June 2018 (prospective analysis). Institutional ethical committee approval was taken.Results:This study concluded that road side accident was the most common cause of traumatic brain injury in elderly in this study. Incidence of traumatic brain injury in elderly was found to be 11.45%. Both non-reacting pupils and low Glasgow coma scale on arrival were significantly associated with poor outcome in terms of mortality. Most of the patients who expired or were discharged against medical advice had associated skull bone fractures, cerebral infarct, diffuse brain edema, subarachnoid hemorrhage, midline shift, lower hemaglobin, higher random blood sugar and higher creatinine as compared to patients who were discharged. All these findings were statistically significant.Conclusion:Low Glasgow coma scale on arrival, non reacting pupils, low hemoglobin, high random blood sugar, high creatinine and intubation on arrival are associated with increased mortality. Associated skull bone fractures, cerebral infarct, diffuse brain edema are predictors of poor outcome. Anticoagulants and associated co-morbidities do not increase the risk of mortality in traumatic brain injury in elderly.

Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan.

Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0–14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January–March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2–97.7%) and 100% (95%CI, 97.7–100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM’s physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury.What is Known:• Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED.What is New:• POCUS with a portable ultrasonography machine, performed by the EM’s physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.

Upper Limb Strikes Reactive Forces in Mix Martial Art Athletes during Ground and Pound Tactics.

Athletes of mixed martial arts use a ground and pound strategy with the strikes in the dominant ground position. The aim of this study was to compare the average peak force (Fpeak) among three punches and to estimate the probability of achieving a skull bone fracture force of 5.1 kN for each type of strike in male and female athletes. A total of 60 males and 31 females (26 ± 8 years, 75 ± 20 kg, 177 ± 11 cm) practicing professional self-defense at the advanced and professional levels performed 15 strikes on a force plate. The analyses of 1360 trials showed significant differences among the strikes Fpeak in females (p < 0.01) and males (p < 0.01). Straight punches had lower Fpeak than palm strikes and elbow strikes in both genders, and palm strikes had higher Fpeak than elbow strikes in females. No difference was observed between palm strikes and elbow strikes in males (p = 0.09). The ground and pound strikes resulted in higher impacts than previously reported strikes in the standing position. Male athletes can deliver a Fpeak above 5.1 kN with a probability of 36% with elbow and palm strikes. Such forces can cause head injury; therefore, the use of these strikes in competition should be carefully considered.

Motor Vehicle Collision Injuries: An Analysis of Facial Fractures in the Urban Pediatric Population.

Motor vehicle collisions (MVC) are a leading cause of unintentional death and injury in the US pediatric population. Compliance with prevention measures such as seatbelts and child safety seats varies considerably with patient demographics. In this study, the authors examine facial fracture secondary to MVC in an urban pediatric population. A retrospective chart review was performed of all facial fractures as a result of MVC in the pediatric population in a level 1 trauma center in an urban environment (University Hospital in Newark, NJ). Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. Seventy-five patients met inclusion criteria for the authors' study. Mean age was 14 years old. Common fracture sites included orbital, mandible, nasal bone, and frontal sinus. Patients were more likely to incur fracture of the zygoma, orbit, nasal bone, frontal sinus, and nasoorbitoethmoid (NOE) if involved in an MVC compared to all other etiologies. Common concomitant injuries included traumatic brain injury, intracranial hemorrhage, and skull and long bone fractures. Open reduction and internal fixation with titanium plates was the most common surgical procedure indicated. Motor vehicle collisions related injury has significant health implications in the urban pediatric population. Orbital, zygoma, and nasal facial fractures and TBI are injuries commonly associated with MVC. The facial fractures are likely due to lack of proper utilization of safety equipment and airbags. Development of effective prevention techniques relies heavily on analysis of injury patterns and management strategies.

Modification of PMMA Cements for Cranioplasty with Bioactive Glass and Copper Doped Tricalcium Phosphate Particles.

Cranioplasty represents the surgical repair of bone defects or deformities in the cranium arising from traumatic skull bone fracture, cranial bone deformities, bone cancer, and infections. The actual gold standard in surgery procedures for cranioplasty involves the use of biocompatible materials, and repair or regeneration of large cranial defects is particularly challenging from both a functional and aesthetic point of view. PMMA-based bone cement are the most widely biomaterials adopted in the field, with at least four different surgical approaches. Modifications for improving biological and mechanical functions of PMMA-based bone cement have been suggested. To this aim, the inclusion of antibiotics to prevent infection has been shown to provide a reduction of mechanical properties in bending. Therefore, the development of novel antibacterial active agents to overcome issues related to mechanical properties and bacterial resistance to antibiotics is still encouraged. In this context, mechanical, biological, and antibacterial feature against P. aeruginosa and S. aureus bacterial strains of surgical PMMA cement modified with BG and recently developed Cu-TCP bioactive particles have been highlighted.

Surgical Elevation for Symptomatic Depressed Skull Fractures Over Dural Venous Sinus

AbstractBackground: Symptomatic depressed skull fractures over dural venous sinus occasionally lead to stenosis, obstruction, or thrombosis and resulting in intracranial hypertension and significant neurological deficit. Some neurosurgeons are treating these cases conservatively for fear of venous hemor-rhage. The surgical elevation of the depressed segment in these cases is a matter of controversy and these patients should be treated carefully.Aim of Study: The aim of this retrospective study was to evaluate outcome after surgical elevation of symptomatic depressed skull bone fracture over dural venous sinus.Patients and Methods: A retrospective study of sympto-matic depressed calvarial fractures presented at Mansoura University Hospital from 2015 to 2018 revealed 11 patients with depressed skull fractures over superior sagittal sinus (n=6) and transverse sinus (n=5). The age ranged from 11-31 years. The causes of these fractures were vehicle accidents and falling from height. Significant neurological deterioration ranged from blurring of vision and motor weakness. MR venography was done in stable and late symptomatic cases to assess sinus patency.Results: Surgical elevation was performed in 10 patients suffered from depressed skull fracture over large venous sinus and conservative treatment for one patient at the transverse sinus and the patient shows patent sinus on MRV and clinically well. Rapid resolution of symptoms and signs as well as sinus patency after elevation.Conclusion: Although the risk of sinus injury during surgical elevation of the depressed segment but it is recom-mended to perform surgery for these symptomatic patients with all precautions required like blood transfusion and preparing vascular graft form the pericranium for sinus repair and this leads to rapid resolution of symptoms and signs as well as sinus patency improvement after elevation.

A Study of Aetiological Profile of Unilateral Sensorineural Hearing Loss

Introduction: It is necessary to identify the aetiology of sudden sensorineural hearing loss for proper management. Despite advancement in the field of diagnostic radiology, immunochemistry and genetic studies, there are still many cases of USNHL where a definite cause cannot be identified. In this study, an attempt has been made to identify the aetiological factors responsible for unilateral sensorineural hearing loss (USNHL).. &#x0D; Materials and Methods: Seventyfive patients with acquired unilateral sensorineural hearing loss without chronic otitis media were included in the study. Hearing was assessed by tuning fork test and pure tone audiometry. Special tests were done to differentiate between cochlear and retrocochlear pathology, to objectively assess hearing loss and to diagnose nonorganic hearing loss. Radio-imaging was done to diagnose skull bone fractures, space occupying lesions in internal auditory meatus and cerebellopontine angle or intracranial pathologies. Biochemical analysis of blood, immunoglobulin and serological assay were done to rule out specific causes.&#x0D; Results: Majority of patients were within 21-30 years of age. 37 patients presented with sudden and remaining with progressive hearing loss. Majority (57.3%) were found to have idiopathic cochlear pathology. Amongst the remaining, there were 8 cases of acoustic trauma, 4 each of Meniere’s disease and cerebellopontine angle tumour and 3 each of Noise-induced hearing loss, labyrinthitis and Non-organic hearing loss. There were 2 cases of meningitis and 1 each of barotrauma, connective tissue disorder, iatrogenic trauma, fracture of petrous bone and cerebrovascular accident. &#x0D; Conclusion: Most of the studies have been done on sudden sensorineural hearing loss. Current study, including sudden and progressive cases, is hence an attempt to ascertain aetiological profile of unilateral SNHL.

Submental Intubation with LMAFastrach&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt; Endotracheal Tube in Maxillofacial Trauma: A Case Report

Securing a definitive airway in patients who require surgical fixation of complex maxillofacial fractures is an integral part of their perioperative management. For the ease of surgical access, an orotracheal tube is usually not preferred by surgeons. The presence of a base of skull or nasal bone fractures would also contraindicate nasotracheal intubation. Therefore, a tracheostomy may be the only option left to secure the airway in these patients who require surgical fixation. Submental intubation has been used as a safe and effective alternative method in patients who require intubation for maxillofacial reconstruction since it was first reported by Hernandez Altemir F in 1986. Many modifications to the original technique have been documented over the years, but there has been no consensus to support the use of a single method or device. In this case report, we described our experience with submental intubation using an LMAFastrachTM endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures. We conclude that the LMAFastrachTM ETT is a suitable device for submental intubation. This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma.

The Outcome and Patterns of Traumatic Brain Injury in the Paediatric Population of a Developing Country Secondary to TV Trolley Tip-Over

Background: Television (TV) trolley tip-over incidences are common and can cause significant morbidity and mortality in children. This study was aimed at analyzing the pattern and outcomes of head injuries resulting from TV trolley tip-over. Method: We conducted a medical chart review of children with TV trolley tip-over head injuries from January 2009 to April 2016. We collected data on demographics, the mechanism of injury, clinical and radiological features of the injury, and outcomes. Outcomes were measured by means of the Glasgow Outcome Scale (GOS) at 6 months (except in 1 case). A descriptive analysis was carried out using SPSS v19. Result: Twenty-two children were included in the study (median age 23.5 months). Sixteen children were male. Most of the children (n = 16) were aged 12-35 months. The median Glasgow Coma Scale score on admission was 15. The median Rotterdam Score for the patients was 2.0. Common symptoms upon admission were vomiting, irritability, scalp laceration, and bruises. Median length of hospital stay was 3 days. Skull bone fractures were present in 12 children. Other CT findings included contusions, extradural and subdural haematomas, intraventricular haemorrhage, and pneumocranium. Surgical intervention was required in 4 cases. Although most of the patients made a good recovery (GOS = 5), 1 patient developed a mild disability and another died in hospital. Conclusion: TV trolley tip-over is most common in toddlers and can lead to significant head injury and mortality. This can be avoided by parental supervision and adjustments in the household.

Clinico-etiological profile and outcome of traumatic head injury in children- a tertiary care experience

Introduction: Children are most vulnerable to head injury, which is one of the most common indications for hospitalization and is often associated with significant morbidity and mortality in severe cases. This study was undertaken to know about the clinical profile, etiology and outcome of head injury in children in a tertiary care hospital. Study Design: Retrospective study. Materials and method: This study was done on 53 children with head injury admitted to pediatric department of Velammal Medical College, Madurai from October 2013- December 2016. Results: Out of the 53 children studied with head injury, males outnumbered (60.3%) females (39.6%). Road traffic accident was the most common cause of head injury (52.8%), followed by accidental fall (47.1%). Vomiting was the most common symptom at admission (58.4%) followed by injuries to scalp and face (41.5%) headache (37.7%), altered sensorium (28.3%). Head injury was mild in severity in 71.6% of childer. Neuro-imaging analysis showed traumatic brain injury in (73.5%) of them, skull bone fractures in (49%), facial bone fractures in (15%) of children. Outcome was measured as with full recovery in 86.7% of children, (5.6%) had partial recovery, death in 3.7% of children. Conclusion: Parental guidance is advised to avoid accidental falls. Implementation of strict traffic rules, timely intervention and aggressive management reduces morbidity and mortality in children with traumatic head injury.

Clinical Significance of Serum Biomarker S100B to Predict Outcome After Traumatic Brain Injury in Adults

Background: Traumatic brain injury (TBI) is a common cause of death and disability, worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement. Serum protein S-100B determinations have been widely suggested the most promising biomarker for TBI. It has been proposed that this marker is useful in a Neurointensive Care Unit (NICU) as a monitoring parameter. The main objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for brain death after severe TBI. Material and methods: In this prospective study, the clinical conditions of patients with mild to moderate TBI were assessed and patient serum S100B levels measured within 24h of injury were eligible for inclusion in the study using by electro chemiluminescence (ECL). Patients were admitted to The Govt. Trauma Centre, P.B.M. Hospital, Bikaner in NICU and followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student’s t-test and the chi-square test were used for the data analysis, which was performed using SPSS software. Result and discussion: The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (20.4 ± 12.6 ng/dl and 124.0 ± 235.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (596.18 ± 502.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 20.97 ± 19.9 ng/dl in patients with normal CT results; 39.56 ± 21.7 ng/dl in patients with skull bone fracture; 50.38 ± 22.9 ng/dl in patients with intracranial haemorrhage; and 70.23 ± 31.3 ng/dl in patients with fracture plus intracranial haemorrhage. Conclusion: Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance. KEYWORDS: Skull bone fracture, Axonal injury, Haemorrhage, Neuropsychological, SPSS Software, Post-traumatic Headache, Abnormal CT

Epidemiological Study of Patterns of Head Injuries in Fatal Road Traffic Accidents in Tripura

Road traffic accidents have become significantly responsible for loss of life, economic and social resources even in our small state of Tripura. With the sudden rise in the number of vehicles in the past ten years the chances of traffic accidents also has risen. The present study has been carried out in the Mortuary of Department of Forensic Medicine and Toxicology, AGMC & GBP Hospital on all the autopsies performed in fatal Road traffic accident cases during the period of 1July 2011 to 30th June 2013 to highlight the patterns of head injuries among road traffic accident victims in this part of the state. Most of the victims in the present study were males and belong to the age group of 21 to 30 years. Most commonly affected victims were the pedestrians with a total number of 84(42.85%) cases. Majority of the victims died within 24 hours of the incident with a total number of 135 (68.87%) cases. Mechanized four wheelers were the most common offending vehicles with a total number of 102 (52.04%) cases. Commonest external injury sustained was contusion with a total number of 180 (91.83%) cases. Skull bone fracture was found in total 96 cases. Subdural haemorrhage was the most common type of intracranial haemorrhage with a total number of 181(92.34%) cases followed by subarachnoid haemorrhage with a total number of 149 (76.02%) cases. Brain contusion is the most common injury encountered by the victims. This study will help in improving data linkages between police, transport and health services.

Ocular and Orbital Injury in All-Terrain Vehicles: A Literature Review

Purpose: To review primary literature on ocular and orbital injury secondary to all-terrain vehicles (ATVs). Methods: A Medline search of English language literature. Results: Very few studies detail ocular and orbital manifestations of ATV crashes. The most common ocular injuries included orbital fractures and eyelid lacerations. Less common but more severe injuries included traumatic optic neuropathy, retinal detachment, optic nerve laceration, and ruptured globe. Associated facial and skull bone fractures, traumatic brain injury, and subdural/subarachnoid hemorrhage were not uncommon. Depending on the mechanism and force of injury, complete loss of vision has been documented. Conclusion: Ocular and orbital trauma can be found in many cases of ATV-related injury. Various interventions may decrease the frequency of such injuries, including use of head and eye protection.

Endocrine dysfunction following traumatic brain injury: a 5-year follow-up nationwide-based study.

Post-traumatic endocrine dysfunction is a complication of traumatic brain injury (TBI). However, there is lack of long-term follow-up and large sample size studies. This study included patients suffering from TBI registered in the Health Insurance Database. Endocrine disorders were identified using the ICD codes: 244 (acquired hypothyroidism), 253 (pituitary dysfunction), 255 (disorders of the adrenal glands), 258 (polyglandular dysfunction), and 259 (other endocrine disorders) with at least three outpatient visits within 1 year or one admission diagnosis. Overall, 156,945 insured subjects were included in the final analysis. The 1- and 5-year incidence rates of post-traumatic endocrinopathies were 0.4% and 2%, respectively. The risks of developing a common endocrinopathy (p < 0.001) or pituitary dysfunction (P < 0.001) were significantly higher in patients with a TBI history. Patients with a skull bone fracture had a higher risk of developing pituitary dysfunction at the 1-year follow up (p value < 0.001). At the 5-year follow up, the association between intracranial hemorrhage and pituitary dysfunction (p value: 0.002) was significant. The risk of developing endocrine dysfunction after TBI increased during the entire 5-year follow-up period. Skull bone fracture and intracranial hemorrhage may be associated with short and long-term post-traumatic pituitary dysfunction, respectively.

CZY BADANIE TOMOGRAFI I KOMPUTEROWEJ JEST KONIECZNE W KAŻDYM PRZYPADKU LEKKIEGO URAZU GŁOWY? ANALIZA MATERIAŁU KLINICZNEGO I RADIOLOGICZNEGO GRUPY CHORYCH

The objective of the study was an assessment of the occurrence of traumatic cerebral lesions and skull fractures in patients with mild head trauma. A total of 171 patients' notes, 89 male (52%) and 82 female (48%), mean age 48 years, were subjected to analysis. Of the 171 patients, in 58 (34%) CT scanning of the head was not performed for various reasons, and these patients were discharged home. Of the remaining 113 persons, who had head CT performed, in 99 (88%) no abnormalities were found; in 10 (9%) CT scans revealed pathological findings unrelated to the trauma: most frequently cortical-subcortical atrophy followed by old post-stroke foci, and in 4 patients (3%) post-traumatic pathologies: skull fractures in 2 and facial bone fractures in 2. Diagnosis of these fractures did not change the conservative treatment of these patients, but only prolonged in-patient stay for 2-3 days. All skull and facial bone fractures occurred in patients who were alcohol intoxicated, were lying, could not maintain vertical position, or who had the "racoon eyes" sign. The results of our study show that lack of abnormalities in neurological examination in patients after mild head injury is a reliable indicator for omitting CT scanning, because the risk of overlooking brain injuries in these patients is minimal. However, patients who are intoxicated, have problems with maintaining a vertical position and have the "racoon eyes" sign, are likely to have skull or facial fractures, and CT scanning is therefore justified. Considering these precursors (guidelines) and the use of clinical decision rules described in the article may reduce the number of head CT scans performed "just in a case".

Analysis of S100 calcium binding protein B serum levels in different types of traumatic intracranial lesions.

The objective of this study was to determine whether the type of intracranial traumatic lesions, the number of simultaneous traumatic lesions, and the occurrence of skull and facial bone fractures have an influence on S100 calcium binding protein B (S100B) serum levels. Patients with blunt traumatic brain injury were prospectively enrolled into this cohort study over a period of 13 months. Venous blood samples were obtained prior to emergency cranial CT scan in all patients within 3 h after injury. The patients were then assigned into six groups: 1) concussion, 2) epidural hematoma, 3) subdural hematoma, 4) subarachnoid hemorrhage, 5) brain contusions, and 6) brain edema. The study included 1696 head trauma patients with a mean age of 57.7 ± 25.3 years, and 126 patients (8%) had 182 traumatic lesions on CT. Significant differences in S100B serum levels were found between cerebral edema and the other four bleeding groups: epidural p = 0.0002, subdural p < 0.0001, subarachnoid p = 0.0001, brain contusions p = 0.0003, and concussion p < 0.0001. Significant differences in S100B values between patients with one or two intracranial lesions (p = 0.014) or with three (p < 0.0001) simultaneous intracranial lesions were found. In patients with intracranial traumatic lesions, skull fractures, as well as skull and facial bone fractures occurring together, were identified as significant additional factors for the increase in serum S100B levels (p < 0.0001). Older age was also associated with elevated S100B serum levels (p < 0.0001). Our data show that peak S100B serum levels were found in patients with cerebral edema and brain contusions.

Serum S100B Protein as an Outcome Prediction Tool in Emergency Department Patients with Traumatic Brain Injury

SUMMARYObjectivesTraumatic brain injury is a common cause of death and disability worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement.MethodsIn this prospective study, the clinical conditions of patients with mild to moderate traumatic brain injury (TBI) were assessed, and patient serum S100B levels were measured. Patients were followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student's t-test and the chi-square test were used for data analysis, which was performed using SPSS software.ResultsThe mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (23.1±14.2 ng/dl and 134.0±245.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (632.18±516.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 24.97±22.9 ng/dl in patients with normal CT results; 41.56±25.7 ng/dl in patients with skull bone fracture; 57.38 ±28.9 ng/dl in patients with intracranial hemorrhage; and 76.23±38.3 ng/dl in patients with fracture plus intracranial hemorrhage).ConclusionsSerum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance.

Demographic Profile and Pathological Patterns of Head Injury in Albania

Introduction: Head injury (HI) is a serious morbid state caused by structural changes of the scalp, skull, and/or its contents, due to mechanical forces. Generally, the most frequent cause of HI is road traffic accident (RTA), followed by homicidal and falling injuries. The aim of present study is to assess epidemiology data, causes and patterns responsible for HI among Albanian subjects. Methodology: All HI cases (1000) are collected by the Forensic Institute of Albania, based on medical and forensic records of traumatized subjects between 2007- 2012. The prospectively-collected and descriptive information is focused on demographic data, responsible factors, type and level of cranial and brain injury, as well as their outcome. Results: The majority of HI victims were male (84%) of age range of 15yrs -35yrs (70%). RTA was the HI cause in 88%, followed by homicides (3.8 %), falling (3%) etc. With respect to injury mechanisms, extra-dural hematoma was found in 93% of cases, followed by cerebral edema (61%), cerebral contusion (37 %), skull bone fractures (35%), etc. Severe alteration of the consciousness was observed in 57% of the cases, while amnesia lasted longer than 4 weeks in 44% of the subjects included in our study. Discussion: This survey demonstrates that the majority of HI victims' is young and middle age males target group exposed to RTA. The increase of vehicles' use in placecountry-regionAlbania is more evident than RTA-related HI, indicating that driving newer vehicles with safer technology or helmets use while motorcycling can potentially decline the fatal outcome.

Prospective Study of Patterns of Injury in Road Traffic Cases

It is a prospective study of 65 road traffic injury cases admitted in M.A.P.I.M.S., which is a tertiary health care centre from January 2010 to December 2011. In the present study, male victims (54 cases, 83%) outnumbered the female victims (11 cases, 17%) with an approximate male-female ratio of 5:1. Four wheelers and two wheelers involving mainly pedestrians were the most common cause for fatal head injury seen in 43 cases, 66% cases. Multiple abrasions were the most commonly seen external injury seen in 58 cases, 89% cases. Skull bone fracture was seen in 26 cases, 40% cases. Temporal and parietal bones were the common site of fracture seen in 27 cases, 41% cases. The mean survival period was 73.42 hours, range being 6 hours to 600 hours.

ENG

<b>Background</b>: No reference is currently available to differentiate fresh and dry bone fractures, caused intentionally or not, for the cranial skeleton. The authors therefore extrapolated characteristics already validated on infra-cranial bones to the skull bones.<br/> <b>Methods</b>: We studied four osteological series which had undergone prior interdisciplinary study to determine the etiology of the fractures.<br/> <b>Results</b>: This analysis allows comparisons to be made between fresh and dry skull bone fractures and enables us to discuss and validate the characteristics traditionally used for the intra-cranial skeleton: fracture angle, cortical delamination, roughness, fracture outline, presence of bone flakes.<br/> <b>Conclusions</b>: Fracture angle, cortical delamination, roughness and fracture outline can be used effectively on osteological series, not on an isolated sample or when taken out of context. We determined that, for an isolated piece of bone, only a large cortical delamination (greater than 10.5 mm) suggests a fresh bone fracture.