Unique Injury Patterns Research Articles

Study of Pattern of Craniofacial Injuries in Road Traffic Accident Cases Autopsied in Midnapore Medical College

Background: The objective of this study was to investigate the pattern of craniofacial injuries in victims of fatal road traffic accidents, observed through autopsies conducted at Midnapore Medical College, West Midnapore from January 2021 to December 2023. Methods: It is a retrospective, cross- sectional observational study. Data was collected by thorough analysis of the injuries documented in post-mortem reports of all the alleged road traffic accident cases where victim sustained Cranio- facial injuries within a time span of 3 years, from 1st January 2021 to 31st December, 2023. Data was analysed using Microsoft Excel. Conclusion: The study highlights the necessity of context-specific interventions to address the unique injury patterns observed in West Midnapore's road traffic accidents. Improving road infrastructure, raising traffic safety awareness, and promoting protective measures like seat belts and helmets can reduce severe craniofacial injuries. The prevalence of maxillofacial fractures underscores the face's vulnerability, with long-term physical and psychological impacts. Effective prevention strategies, such as strict traffic regulations and awareness campaigns on the dangers of distracted or impaired driving, are essential. Despite limitations, the study provides valuable insights into craniofacial injury patterns in fatal accidents, stressing the need for enhanced road safety, stronger traffic laws, and better post-accident care. Interdisciplinary collaboration among healthcare professionals, law enforcement, and policymakers is crucial for developing comprehensive strategies to manage and prevent these injuries. By examining regional injury characteristics and comparing them with other studies, this research contributes to the broader understanding of craniofacial trauma, offering significant implications for improving road safety, trauma care, and forensic practices.

Derivation and validation of generalized sepsis-induced acute respiratory failure phenotypes among critically ill patients: a retrospective study

BackgroundSeptic patients who develop acute respiratory failure (ARF) requiring mechanical ventilation represent a heterogenous subgroup of critically ill patients with widely variable clinical characteristics. Identifying distinct phenotypes of these patients may reveal insights about the broader heterogeneity in the clinical course of sepsis, considering multi-organ dynamics. We aimed to derive novel phenotypes of sepsis-induced ARF using observational clinical data and investigate the generalizability of the derived phenotypes.MethodsWe performed a multi-center retrospective study of ICU patients with sepsis who required mechanical ventilation for ≥ 24 h. Data from two different high-volume academic hospital centers were used, where all phenotypes were derived in MICU of Hospital-I (N = 3225). The derived phenotypes were validated in MICU of Hospital-II (N = 848), SICU of Hospital-I (N = 1112), and SICU of Hospital-II (N = 465). Clinical data from 24 h preceding intubation was used to derive distinct phenotypes using an explainable machine learning-based clustering model interpreted by clinical experts.ResultsFour distinct ARF phenotypes were identified: A (severe multi-organ dysfunction (MOD) with a high likelihood of kidney injury and heart failure), B (severe hypoxemic respiratory failure [median P/F = 123]), C (mild hypoxia [median P/F = 240]), and D (severe MOD with a high likelihood of hepatic injury, coagulopathy, and lactic acidosis). Patients in each phenotype showed differences in clinical course and mortality rates despite similarities in demographics and admission co-morbidities. The phenotypes were reproduced in external validation utilizing the MICU of Hospital-II and SICUs from Hospital-I and -II. Kaplan–Meier analysis showed significant difference in 28-day mortality across the phenotypes (p < 0.01) and consistent across MICU and SICU of both Hospital-I and -II. The phenotypes demonstrated differences in treatment effects associated with high positive end-expiratory pressure (PEEP) strategy.ConclusionThe phenotypes demonstrated unique patterns of organ injury and differences in clinical outcomes, which may help inform future research and clinical trial design for tailored management strategies.

Long-Term Disability After Traumatic Spinal Injuries: A Military Retrospective Study.

Traumatic spinal injuries (TSI) pose a significant life-long burden, impacting both military and civilian populations. Assessing long-term outcomes is crucial for comprehending the enduring consequences of the initial insult and informing effective prevention and management strategies. Most existing studies have narrowly focused on subsets of traumatic cord injuries, leaving a gap in understanding the broader impact of severe spinal trauma. This study aims to examine severe TSIs in military personnel, who may face unique risk factors and injury patterns, and its association with long-term disability. A retrospective cohort study was conducted on all military personnel who suffered traumatic injuries (Injury Severity Score ≥ 9) from 1997 to 2020. Severe spinal injuries were defined using the spinal Abbreviated Injury Scale ≥ 3 (n = 95), and compared to all other injuries as a reference group (n = 1,394). Data were extracted and cross-referenced from three distinct nationwide registries-pre-hospital, admission, and rehabilitation. Logistic regression analysis was used to evaluate the impact of spinal injuries on long-term disabilities (defined as the highest possible disability tier). The study received approval from the institutional review board of the Israel Defense Forces Medical Corps. Motor vehicle accidents and falls were the primary causes of spinal injuries (50.5% and 15.8%, respectively). The median age at injury was 20 years (interquartile range 19-22). Personnel with spinal trauma had a significantly higher prevalence of Injury Severity Score ≥ 25 (46.3% vs. 19.9%, P < .001), longer median hospital stays (11 vs. 8 days, P = .036), and increased intensive care unit admissions (55% vs. 40%, P = .05). The median follow-up duration was 10.9 years (interquartile range 6.7-14.3). Spinal injuries were associated with a more than 10-fold increase in the adjusted odds ratio for severe permanent disability (11.92, 95% CI, 5.95-23.72). Upon long-term follow-up, military personnel with severe TSI exhibit a significantly higher prevalence of debilitating disability compared to those with significant non-spinal traumatic injuries. These findings highlight the critical need for targeted prevention strategies and improved management of spinal injuries to reduce long-term disability. Strengths of this study include its extensive follow-up period and the use of multiple nationwide registries. However, the study may be limited by potential discrepancies in identity matching across databases and the reliance on disability claims, which may underrepresent the true prevalence of long-term disability. Future research should explore the efficacy of early interventions and rehabilitation strategies in mitigating long-term disability following spinal injuries. This study underscores the importance of developing evidence-based policies to enhance care for individuals with TSIs.

Unique brain injury patterns after proton vs photon radiotherapy for WHO grade 2-3 gliomas.

Central nervous system (CNS) injury following brain-directed radiotherapy remains a major challenge. Proton radiotherapy (PRT) minimizes radiation to healthy brain, potentially limiting sequelae. We characterized CNS radiotoxicity, including radiation-induced leukoencephalopathy (RIL), brain tissue necrosis (TN), and cerebral microbleeds (CMB), in glioma patients treated with PRT or photons (XRT). Thirty-four patients (19 male; median age 39.6 years) with WHO grade 2-3 gliomas treated with partial cranial radiotherapy (XRT [n = 17] vs PRT[n = 17]) were identified and matched by demographic/clinical criteria. Radiotoxicity was assessed longitudinally for 3 years post-radiotherapy via serial analysis of T2/FLAIR- (for RIL), contrast-enhanced T1- (for TN), and susceptibility (for CMB)-weighted MRI sequences. RIL was rated at whole-brain and hemispheric levels using a novel Fazekas scale-informed scoring system. The scoring system proved reliable (ICC > 0.85). Both groups developed moderate-to-severe RIL (62%[XRT]; 71%[PRT]) within 3 years; however, XRT was associated with persistent RIL increases in the contralesional hemisphere, whereas contralesional hemispheric RIL plateaued with PRT at 1-year post-radiotherapy (t = 2.180; P = .037). TN rates were greater with PRT (6%[XRT] vs 18%[PRT]; P = ns). CMB prevalence (76%[XRT]; 71%[PRT]) and burden (mean #CMB: 4.0[XRT]; 4.2[PRT]) were similar; however, XRT correlated with greater contralesional hemispheric CMB burden (27%[XRT]; 17%[PRT]; X2 = 4.986; P = .026), whereas PRT-specific CMB clustered at the radiation field margin (X2 = 14.7; P = .002). CNS radiotoxicity is common and progressive in glioma patients. Injury patterns suggest radiation modality-specificity as RIL, TN, and CMB exhibit unique spatiotemporal differences following XRT vs PRT, likely reflecting underlying dosimetric and radiobiological differences. Familiarity with such injury patterns is essential to improve patient management. Prospective studies are needed to validate these findings and assess their impacts on neurocognitive function.

Pediatric Facial Fractures: Demographics, Injury Patterns, and Associated Injuries in 3334 Patients.

Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts because of unique injury patterns and effects on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific. In contrast, our study presents a comprehensive assessment of all pediatric facial fracture patients seen at a single institution. Patients under 18 years old who were evaluated for facial fractures at a level I pediatric trauma center between 2006 and 2021 were reviewed. Subanalysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management, and outcomes. Three thousand thirty-four patients were included. Mean age at presentation was 11.5 to 4.9 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12y), compared with activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (P<0.001), whereas operative intervention increased with age (P<0.001). Zygomaticomaxillary complex (P=0.002) and nasal fractures (P<0.001) were common in older patients, whereas younger patients experienced more skull (P<0.001) and orbital fractures (P<0.001). The most associated injuries were soft tissue (55.7%) and neurologic (23.6%). This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

Complex Axial Carpal Dislocation with Scapholunate Ligament Injury

Abstract Background Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively. Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury. Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability. Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.

Lesions of the rotator cuff and biceps tendon

The rotator cuff is acomplex anatomical structure and the integrity is pivotal for the shoulder functionality. The pathologies are often multifactorial, resulting from degenerative, vascular, traumatic and mechanical factors. Radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) form the pillars of radiological diagnostics. Each modality has specific advantages and limitations in the visualization and assessment of pathologies of the rotator cuff and biceps tendon. The MR arthrography offers additional insights in unclear cases by enhancing the differentiation between complete and partial tears. The MRI provides detailed information on tendon quality and associated damages, such as muscle atrophy and fat infiltration, making it the preferred method. The use of MR arthrography can identify defects through increased intra-articular pressure or contrast medium leakage. Muscle damage, as induced by edema in acute injuries or fatty degeneration in chronic conditions, can be evaluated using imaging techniques. Special attention is warranted for the infraspinatus, subscapularis and teres minor muscles due to their unique injury patterns and prevalences.

The Perfect Med Bag is One that Doesn't Fall Off a Cliff: A Combat Mass Casualty Case.

Military trauma provides a unique pattern of injuries due to the high velocity, high kinetic energy ammunition utilized, and the high prevalence of blast injury. To further complicate this, military trauma often occurs in austere environments with limited logistical support. Therefore, military medical providers are forced to learn nonstandard techniques and when necessary, practice a level of improvisation not commonly seen in other medical fields. The case presented in this manuscript is a prime example of these challenges. At the onset of fighting both the medic's rucksack, carrying with it the primary source of medical gear and the precious supply of cold-stored blood products are lost. The scenario was further complicated by rough mountainous terrain and a prolonged evacuation time. The medical provider was forced to utilize nonstandard devices such as an improvised junctional tourniquet which used a rock to focus the devices pressure. They also adapted their basic understanding of surgical procedures to conduct a vascular cutdown procedure for wound exposure and effectively pack an otherwise non-compressible wound to a major artery. Despite a significant loss of equipment, the medic and their team were able to successfully care for a number of patients in this mass casualty scenario.

Kidney Biopsy Findings and Clinical Outcomes of US Veterans with Inflammatory Bowel Disease

Introduction: Patients with inflammatory bowel disease (IBD; ulcerative colitis [UC] and Crohn’s disease [CD]) may have unique patterns of kidney injury related to their underlying or coexisting disease or to medications. We present the kidney biopsy findings and clinical outcomes of veterans with UC or CD from the US Department of Veteran’s Affairs (VA) health system. Methods: Histopathologic and clinical data were extracted by retrospective review of the VA electronic health record of patients with IBD and a kidney biopsy between 2000 and 2018. Incident end-stage kidney disease (ESKD) was defined as requirement of kidney replacement therapy. Statistical analyses were performed using SAS. Results: A total of 140 patients (UC: 91 and CD: 49) underwent kidney biopsy. The three most common diagnoses were IgA nephropathy (17.1%), diabetic nephropathy (14.3%), and acute interstitial nephritis (9.3%). Significant interstitial fibrosis, tubular atrophy, and arteriosclerosis were present in 45% of biopsies. Twenty-six percent of patients with UC and 20% of those with CD progressed to ESKD, with a mean time from kidney biopsy of 3.1 and 1.9 years, respectively. Forty-five percent of patients with UC and 34% of those with CD died, with a mean time from kidney biopsy of 4.3 and 4.6 years, respectively. Conclusion: Among US veterans with IBD who underwent a kidney biopsy, IgA nephropathy, diabetic nephropathy, and interstitial nephritis were among the most common findings. Additionally, features of advanced kidney disease with rapid clinical progression to ESKD or death were observed. These findings suggest a delay and possibly a low rate of diagnosis.

Adolescent track and field injuries presenting to US emergency departments

ABSTRACT Objectives Track and field (T&F) is a highly popular sport for adolescents. The diversity of running, jumping, and throwing events within the sport can result in unique injury patterns for adolescent track and field participants. The purpose of this study was to estimate injury risk in adolescent T&F and describe the types of injuries resulting in ED visits, classified by T&F events. Methods Emergency department (ED) data from the National Electronic Injury Surveillance System were obtained for a 20-year period from 2000 through 2019. Cases involving 14- to 18-year-olds participating in T&F were classified by sex, case severity, involved body region, and the T&F event patients were engaged in at the time of their injury. National estimates and Injury rates were calculated using national high school T&F participation data. Longitudinal trends in ED visits were measured using linear regression. Rate ratios (RRs) were used to compare the risk and severity of ED visits by sex. Results 8,060 track and field related ED encounters were observed, representing an estimated 272,227 encounters nationally over the 20-year study period. The rate of ED encounters increased significantly over the study period (p < 0.001). Adolescent females exhibited a higher rate of ED encounters (RR: 1.23, 95% CI: 1.22–1.24), but a lower rate of hospital admissions (RR: 0.68, 95% CI: 0.64–0.73) compared to males. The lower extremity was the most commonly injured body region for most T&F events, but this differed for sprinting, high jumping, shot put, and javelin events. Most T&F events resulted in unique injury patterns characteristic of their athletic demands. Conclusions There was an increasing trend of ED visits from adolescent T&F participants throughout the 20-year study period with different injury patterns observed by sex and T&F event discipline.

Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole Severe Acute Respiratory Failure.

Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs. A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children's Mercy Hospital Genomic Center and Vanderbilt University Medical Center. U.S. ICUs, 1996-2021. Nineteen young patients (10-37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping. None. Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, ( n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered. TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.

Imaging Diagnosis and Management of Carpal Trauma and Instability-An Illustrated Guide.

Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.

Combined pelvic and acetabular injuries: clinical features and treatment strategies of a unique injury pattern

BackgroundTo explore the clinical characteristics of patients with unstable pelvic fractures combined with acetabular fractures and to discuss the treatment strategies for such patients to help guide treatment.MethodsWe retrospectively assessed 24 patients admitted to our hospital from June 2018 to June 2022 with unstable pelvic fractures combined with acetabular fractures, including 15 male patients and 9 female patients with a mean age of 44.8 years. According to the Tile pelvic fracture classification, 15 cases were type B, and 9 cases were type C. The acetabular fractures were classified using the Letournel–Judet classification. There were 8 transverse fractures, 4 transverse and posterior wall fractures, 3 anterior and posterior hemitransverse fractures, 6 both-column fractures, 2 T-shaped fractures and 1 anterior column fracture. We recorded the cause of the patient's injury and vital signs on admission and assessed the patient's treatment strategy and prognosis.ResultsAll patients completed the surgery successfully, and the follow-up ranged from 6 to 42 months, with a mean of 23 months. The healing time for pelvic fractures ranged from 11 to 21 weeks, with a mean of 14.8 weeks, and the postoperative displacement of the posterior pelvic ring ranged from 1.2 to 9.0 mm, with a mean of 3.5 mm. The final clinical outcome at follow-up was evaluated using the Majeed scale: excellent in 11 cases, good in 10 cases and fair in 3 cases; the excellent rate was 87.5%. The time to healing of the acetabular fracture ranged from 13 to 25 weeks, with a mean of 15.9 weeks, and the postoperative displacement of the acetabular fracture ranged from 0.6 to 5.2 mm, with a mean of 1.9 mm. Hip function was assessed at the final follow-up using a modified Merle D’ Aubigné and Postel scale: there were 9 excellent, 11 good and 4 acceptable scores; an excellent rate of 83.3% was achieved.ConclusionPatients with unstable pelvic fractures combined with acetabular fractures suffer severe trauma and complex mechanisms of injury. Treatment needs to be individualized, taking into account the patient's physiological status, fracture classification and degree of displacement.

Consensus and Equipose in the Management of Military Trainee Femoral Neck Stress Fractures: A Survey of Military Surgeons.

Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF. We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF. A 27-question survey was created and sent to U.S. military orthopedic surgeon members of the Society of Military Orthopaedic Surgeons. The survey was designed in order to gather the experience among surgeons in treating FNSF and identifying variables that play a role in the treatment algorithm for these patients. In addition, seven detailed, clinical vignettes were presented to further inquire on surgeon treatment preferences. Binomial distribution analysis was used to evaluate for common trends within the surgeon's treatment preferences. Seventy orthopedic surgeons completed the survey, the majority of whom were on active duty status in the U.S. Military (82.86%) and having under 5 years of experience (61.43%). Majority of surgeons elected for a multiple screw construct (92.86%), however the orientation of the multiple screws was dependent on whether the fracture was open or closed. Management for compression-sided FNSF involving ≥50% of the femoral neck width, tension-sided FNSF, and stress fractures demonstrating fracture line progression had consensus for operative management. Respondents agreed upon prophylactic fixation of the contralateral hip if the following factors were involved: Complete fracture (98.57%), compression-sided fracture line >75% (88.57%), compression-sided fracture line >50-75% with hip effusion (88.57%), contralateral tension-sided fracture (87.14%), and compression-sided fracture line >50-75% (84.29%). An FNSF < 50% on the contralateral femoral neck or a hip effusion was indeterminate in surgeons indicating need for prophylactic fixation. Majority of surgeons (77.1%) utilized restricted toe-touch weight-bearing for postoperative mobility restrictions. Consensus exists for surgical and non-surgical management of FNSF by U.S. military orthopedic surgeons, despite the preponderance of surgeons reporting a low annual volume of FNSF cases treated. However, there are certain aspects in the operative and non-operative management of FNSF that are unanimously adhered to. Specifically, our results demonstrate that there is no clear indication on the management of FNSF when an associated hip effusion is involved. Additionally, the indications for surgically treating contralateral FNSF are unclear. IV.

The use of whole-body trauma CT should be based on mechanism of injury: A risk analysis of 3920 patients at a tertiary trauma centre

BackgroundMechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making. MethodsRetrospective cohort study including all patients >18 years old who received a whole-body CT scan between 1 January 2019 and 19 February 2020. The outcomes were divided into CT ‘positive’ if any internal injuries were detected and CT ‘negative’ if no internal injuries were detected. The MOI, vital sign parameters, and other relevant clinical examination findings at presentation were recorded. Results3920 patients met the inclusion criteria, of which 1591 (40.6%) had a positive CT. The most common MOI was fall from standing height (FFSH), accounting for 23.0%, followed by motor vehicle accident (MVA), accounting for 22.4%. Covariates significantly associated with a positive CT included age, MVA >60 km/h, motor bike, bicycle, or pedestrian accident >30 km/h, prolonged extrication >30 min, fall from height above standing, penetrating chest or abdominal injury, as well as hypotension, neurological deficit, or hypoxia on arrival. FFSH was shown to reduce the risk of a positive CT overall, however, sub-analysis of FFSH in patients >65 years showed a significant association with a positive CT (OR 2.34, p < 0.001) compared to <65 years. ConclusionsPre-arrival information including MOI and vital signs have significant impact on identifying subsequent injuries with CT imaging. In high energy trauma, we should consider the need for whole-body CT based on MOI alone regardless of the clinical examination findings. However, for low-energy trauma, including FFSH, in the absence of clinical examination findings which support an internal injury, a screening whole-body CT is unlikely to yield a positive result, particularly in the age group <65yo.

A scoping review of two decades of pediatric humanitarian care during wartime.

Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting. We sought to perform a scoping review of pediatric research from the recent US-led wars in Afghanistan, and Iraq conflicts beginning in 2001. We used Google Scholar and PubMed to identify pediatric combat literature published between 2001 and 2022. We utilized the PRISMA-ScR Checklist to conduct this review. We identified 52 studies that met inclusion for this analysis-1 prospective observational study, 50 retrospective studies, and 1 case report. All the original research studies were retrospective in nature except for one. We identified one prospective study that was a post hoc subanalysis from an overall study assessing the success of prehospital lifesaving interventions. Most of the articles came from varying registries created by the United States and British militaries for the purposes of trauma performance improvement. The deployed health service support mission often includes treatment of pediatric trauma patients. The deployed health service support mission often includes treatment of pediatric trauma patients. We found that available literature from this setting is limited to retrospective studies except for one prospective study. Our findings suggest that pediatric humanitarian care was a significant source of medical resource consumption within both of the major wars. Further, many of the lessons learned have directly translated into changes in civilian pediatric trauma care practices highlighting the need for collaborative scientific developments between the military and civilian trauma programs. Systematic Review/Meta-Analyses; Level III.

Injury Outcomes of the 2017 Charlottesville TARMAC Attack

Introduction:Targeted Automobile Ramming Mass Casualty attacks (TARMAC) have occurred worldwide since 2010. The dramatic increase in incidence warrants special attention to the unique pattern of injury associated with such attacks as they are unlike any other type of intentional trauma. This study characterizes the resulting injuries from the 2017 Charlottesville, Virginia TARMAC attack.Method:Patient records of victims were identified and analyzed for injuries, demographics, and surgical needs. The data were evaluated for patterns.Results:Nineteen TARMAC victims were treated in the UVAHS Emergency Department. Most were female (68%). Average age was 29.4 years (range 13 – 72 years). Data showed seven ICU admissions, four standard admissions, and seven discharges. There was one fatality and the specific injury data was unavailable. Most injuries were orthopedic: lower extremity fractures (n=7) [2 open], upper extremity fractures (n=7), axial skeleton fractures (n=6), and a facial fracture (n=1). Arterial injuries required interventional radiology (n=1) or observation (n=2). Organ injuries included a Grade 1 spleen laceration (n=1) and pneumomediastinum (n=1). six victims required one or more operative interventions during admission: emergent procedures (n=6) and delayed procedures (n=4). In the Emergency Department, two bony reductions were performed, five lacerations were repaired, and one thoracotomy was performed. Injury Severity Scores were calculated (mean=11.5; median 6; range 1-75).Conclusion:Due to the mechanism of injury, TARMAC attacks inflict a unique wounding pattern. Intentional mass blunt trauma is previously unknown to emergency medicine. Vehicle variables including weight, speed, and bumper height affect the injury location and severity. This vehicle, a low-height sports car, inflicted primarily lower extremity injuries. Mortality rates have been higher in attacks involving taller, heavier vehicles, as seen in France, Germany, and Sweden. Analysis of victim data from TARMAC attacks will help emergency medicine physicians, surgeons, and disaster medicine specialists to prepare, train, and mitigate against this increasingly frequent tactic.

D155. Demographics, Injury Patterns and Associated Injuries in 3,334 Pediatric Facial Fracture Patients Treated at a Single Institution

PURPOSE: Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts due to unique injury patterns and effect on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific; in contrast, our study presents a comprehensive descriptive report of all pediatric facial fracture patients seen at a single institution. METHODS: Patients under 18 years old who were evaluated for facial fractures at a Level I pediatric trauma center between 2006 and 2021 were reviewed. Sub-analysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management and outcomes. RESULTS: 3,334 patients were included. Mean age at presentation was 11.5 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12 years), compared to activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (p<0.001), while operative intervention increased with age (p<0.001). Zygomaticomaxillary complex (p=0.002) and nasal fractures (p<0.001) were common in older patients, while younger patients experienced more skull (p<0.001) and orbital fractures (p<0.001). The most common associated injuries were soft tissue (55.7%) and neurologic (23.6%). CONCLUSION: This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

Extensive Tongue Laceration in an Edentulous Infant: Is It Child Abuse?

It is important for medical providers to distinguish between accidental and abusive mechanisms of injury in children. In the absence of a serious trauma, an isolated tongue laceration and oromaxillofacial trauma in a young, edentulous infant raises significant concern for abuse. The presented case demonstrates a unique injury pattern and serves as an opportunity to explore the multidisciplinary approach to infant trauma in Otolaryngology. Presented is an edentulous infant who sustained a deep splitting laceration of the oral tongue as a result of being dropped a short distance onto carpeted floor. This injury pattern, in the absence of other trauma, raised concern for abuse. Hospital social work and Child Abuse Pediatrics further investigated the matter. A surveillance camera video was produced which demonstrated the blunt force of the fall, coupled with the friction sliding on the floor, ripped open the infant's tongue and left a pattern otherwise suspicious for sharp object laceration. To our knowledge, this is the first report describing a full-thickness tongue laceration after a fall from a caregiver's arms onto carpeted ground. This case underscores the responsibility of the astute provider coupled with a multidisciplinary team to identify or rule out potential child abuse.

Fracture-Dislocations of the Elbow: A Comparison of Monteggia and Terrible Triad Fracture Patterns.

Fracture-dislocations of the elbow are a spectrum of injuries that have varying outcomes and complications, such as limited range of motion and long-term pain. The Monteggia fracture-dislocation and terrible triad fracture-dislocation are 2 such injury patterns that occur secondary to different mechanisms. This study sought to compare complication profiles and patient outcomes associated with these 2 distinct injury patterns. A retrospective chart review of all adult patients treated by 1 of 3 orthopedic traumatologists at a major academic center for operative fixation for either a Monteggia fracture-dislocation or a terrible triad elbow fracture-dislocation over a 12-year period was performed. Data collected included demographics, surgical data, patient-reported pain and elbow stiffness, elbow range of motion, presence of elbow joint contracture, nerve injuries, healing complications, and need for reoperation. The review included 105 patients, 58 with Monteggia injury and 47 with terrible triad injury, who had complete follow-up and radiographic imaging available. At latest follow-up, the 2 groups had similar rates of pain, reoperation, and ultimate elbow range of motion in flexion, extension, pronation, and supination. Elbow contractures requiring operative release were more commonly associated with terrible triad injury, and the incidence of nonunion was significantly greater in Monteggia fractures. A Monteggia fracture-dislocation portends a higher risk of ulna nonunion, whereas terrible triad injury is associated with elbow contracture. Despite their unique complications, both patterns ultimately have high rates of reoperation as their unique complications are both indications for operative repair. Patients should be appropriately counseled on the complication profile of their unique injury pattern. [Orthopedics. 2023;46(3):158-163.].