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Introduction: Bladder rupture following blunt pelvic trauma is rare though can have significant sequelae. We sought to determine whether machine learning could help predict the presence of bladder injury using certain factors at the time of presentation of blunt pelvic trauma., Materials and Methods: Adult patients at a Level I trauma center with blunt trauma pelvic fractures from January 1, 2005 to December 31, 2017 were identified. Patients with admission urinalysis data, fracture ICD 9 codes, and mechanism of injury available in the trauma registry were included. Patients with bladder rupture and pelvic fracture were compared to those with pelvic fracture alone. The classification of results was performed using the MATLAB Classification Learner Tool. The classification performances were tested by machine learning algorithms in the domains of Decision Tree, Logistic Regression, Naïve Bayes, Support Vector Machine (SVM), Nearest Neighbor (KNN), and Ensemble classifiers., Results: Of the 3063 eligible pelvic fracture patients identified, 208 (6.8%) had concomitant bladder ruptures. Twenty machine learning algorithms were then tested based on pelvic fracture ICD-9 code, admission urinalysis, and mechanism of injury. The best classification results were obtained using the Gaussian Naïve Bayes and Kernel Naïve Bayes classifiers, both with accuracy of 97.8%, specificity of 99%, sensitivity of 83%, and area under the curve (AUC) of the ROC curve of 0.99., Conclusion: Machine learning algorithms can be used to help predict with a high level of accuracy the presence of bladder rupture with blunt pelvic trauma using readily available information at the time of presentation. This has the potential to improve selection of patients for additional imaging, while also more appropriately allocating hospital resources and reducing patient risks., Competing Interests: Declaration of Competing Interest Authors have no conflicts of interest to report., (Published by Elsevier Ltd.)

Introduction and Aim: Anterior cruciate ligament (ACL) tears are common injuries. Despite the diagnosis being in essence a clinical one, this has often proved unreliable. The objective of this study was to ascertain the delay to diagnosis of ACL injury from initial presentation and subsequent delay to review by a knee specialist., Methods: The study involved a retrospective review of 130 patient case notes in a consecutive series of patients undergoing primary ACL reconstruction. Details regarding mechanism of injury, dates of initial and subsequent clinic attendances and the treating health-care professional were recorded. Other information included dates of magnetic resonance imaging (MRI) scans and when a patient first saw a knee specialist. From this, delays to clinical or radiological diagnosis were calculated., Results: There were 82 acute and 48 chronic ACL injuries. Overall, the initial treating practitioner made the diagnosis in only 25 patients, yielding a diagnostic rate of 19.2%. Diagnoses made on MRI scan accounted for 38.5% of cases, the remainder being diagnosed clinically. The mean delay to diagnosis of ACL rupture was 65 days, and only 53 patients were diagnosed within 30 days of initial presentation. A total of 15 patients had undergone arthroscopy, eight of which were diagnostic. The mean delay to consulting a soft-tissue knee surgeon was 165 days. In the acute group, the initial diagnostic rate was only 7.3% and the mean delay to diagnosis was 82 days, with 29 patients diagnosed within 30 days., Conclusions: Despite 78% of the patients having a typical mechanism of ACL injury, and most attending acutely via the Emergency Department (ED), diagnosis of this common injury remains tardy. There has been at best only minor improvement in the diagnostic rate and delays, certainly of acute ACL injury, since a study in 1996. The overall clinical diagnostic rate remains disconcertingly low as does the delay to consulting a soft-tissue knee specialist., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: Routinely collected hospital discharge data are a valuable and widely used source of information when assessing the incidence of sports and other injuries in epidemiological studies. However, in order to ensure the usefulness of a hospital discharge register for scientific purposes, the coverage and accuracy of the database should be evaluated. In this study, cruciate ligament rupture was used to assess the coverage and accuracy of the Finnish National Hospital Discharge Register (NHDR)., Materials and Methods: The coverage of the diagnosis of cruciate ligament injury in the NHDR was examined by comparing patients with a confirmed cruciate ligament injury in the arthroscopy register of the Finnish Central Military Hospital (N=262) to their register data in the NHDR. To assess the accuracy of this diagnosis in the NHDR, the original medical reports including magnetic resonance imaging (MRI) and arthroscopy files were reviewed., Results: Of the above noted 262 conscripts with a confirmed cruciate ligament injury, 241 were found to be correctly coded in the NHDR (register coverage 92%). Concerning register accuracy, of the 217 patients having cruciate ligament injury as the main or secondary diagnosis in the NHDR, 194 were confirmed to have this injury as verified by MRI or arthroscopy of the knee (register accuracy 89%)., Conclusions: Our results showed that the coverage and accuracy of diagnosis registration of a cruciate ligament injury of the knee in the Finnish NHDR are very good. Further multi-centre studies are needed to confirm our findings.

Diaphragmatic injuries following blunt trauma are rare. From January 1988 to February 2002 eight children were treated at the Children's Hospital at Westmead for diaphragmatic injury. Male to female ration was 5:3. Motor vehicle crashes were the most common cause. The injury was left-sided in four, right sided in three and central in one. Initial plain radiograph and computerised tomography detected the injury in 50% of cases. Laparotomy, contrast study and autopsy identified the rupture in one each. Associated injuries were present in all cases. Seven children had laparotomy and repair of the diaphragmatic rupture. The commonest site of rupture was posterolateral (37.5%). Diagnosis was delayed in two cases. There were two deaths (25% mortality) in the series, both due to associated injuries. Although rare, diaphragmatic rupture must be considered in any child with thoracoabdominal injury. Diagnosis may be difficult and require extensive investigation. Mortality usually results from associated injuries.

Traumatic diaphragmatic rupture is reported with increasing frequency and is associated with high morbidity and mortality. The purpose of this study was to present our experience with the management of this injury. Sixty-five patients with TDR were treated in our hospital between January 1989 and May 2000. They were 54 men (83%) and 11 women (17%). Mean age was 36.57 years (range 15-76 years). Rupture of the diaphragm was left-sided in 43 patients (66%), right-sided in 21 (32%), and bilateral in 1 (1.5%). Blunt trauma accounted for the injuries of 52 patients (80%). Early diagnosis was obtained in 57 patients (88%). The diagnosis was established preoperatively in 17 patients (26%), and intra-operatively in 48 (74%). Multiple associated injuries were observed in 62 patients (95%). Postoperative complications were observed in seven patients (11%), and the overall mortality was 14%. Injury severity score (ISS) and haemorrhagic shock upon admission strongly influence the outcome. A high index of suspicion and a thorough examination of both hemi diaphragms during laparotomy is recommended in order to avoid early or late complications.

Between 1979 and 1994, 75 patients underwent primary repair of a Grade III rupture of the lateral ligament of the ankle. The operation was indicated after the demonstration of ankle instability on stress X-rays by anterior displacement of the talus by more than 8 mm or/and a talar tilt of more than 10 degrees. The patients were either young or engaged in sports activities or physically demanding jobs. An end-to-end suture of the torn ligament was undertaken under general anaesthesia. A non-weight-bearing cast was used for the first 2 weeks, followed by a walking cast until 6 weeks postoperatively. Sixty-one patients were followed up for 1-15 years (mean 10.3 years). At follow-up all but one patient had returned to their pre-injury level of activity without complaint or restriction.

Twelve cases of traumatic rupture of a massive hydronephrosis are reported. The key points in the diagnosis are: injury around the loin, peritonitis, a fall of pH in the abdominal paracentesis fluid, a rise of blood urea nitrogen (BUN) and structural abnormality of the affected renal pelvis seen on ultrasonography. The treatment differed according to the disease causing the hydronephrosis before the injury. All patients were treated surgically with a satisfactory overall cure rate. Follow-up of 12 years has not revealed any significant sequelae.

One hundred and seventeen consecutive patients with 119 anterior cruciate deficient knees presenting to a knee clinic were studied to analyse an apparent poor diagnosis rate by referring doctors. The diagnosis had been made by the original treating physician in only 9.8 per cent of cases. Thirty per cent of the patients had been seen by an orthopaedic consultant without the diagnosis being made. Thirty-six patients had undergone 51 invasive investigations, including arthroscopy, without the diagnosis being made. This was despite 90 per cent of patients having a typical history and all having unequivocal physical signs. The average delay in diagnosis was 21 months.

A total of 220 consecutive young adults with a traumatic effusion of the knee joint, seen initially in the accident and emergency department, have been reviewed in a weekly orthopaedic acute knee clinic. Of the patients, 80 per cent were seen within 3 days of the injury, and all patients were seen within 8 days of the injury. There were 62 patients (28 per cent) with damage to the anterior cruciate ligament (ACL), of whom 37 patients (17 per cent) had acute complete ACL tears. There were 92 haemarthroses in this series, in which there was a high incidence of ACL damage. The Lachman test was used in this study and identified 73 per cent of the acute complete ACL tears preoperatively and all the chronic ACL injuries. Acute ACL injuries can be diagnose early provided adequate resources are available to provide clinic and theatre facilities. Early diagnosis enables the patients to be given clear advice on future job and sports prospects and allows selection of patients most likely to benefit from augmented repair of the ligament. Associated meniscal lesions can also be identified and treated at an early stage.

The reliability of clinical assessment of the knee was evaluated in 203 patients using magnetic resonance imaging (MRI). Neither the mechanism of injury nor clinical symptoms were useful indicators of the type of pathology. Physical signs proved insufficiently sensitive in detecting abnormalities. Overall, the accuracy of clinical diagnosis was 80.8 per cent for the anterior cruciate ligament, 62.9 per cent for the medial meniscus and 74.9 per cent for the lateral meniscus. Accurate investigations allow arthroscopy to be targeted to those likely to obtain therapeutic benefit. Reliance upon clinical judgement alone would have resulted in an 89 per cent increase in arthroscopic procedures. Investigations such as MRI or arthrography are concluded to be cost-effective methods of avoiding unnecessary hospitalization, morbidity and waste of limited resources.

Little is known of the exact aetiology of traumatic stricture of the urethra, but the first clinical presentation can be delayed many years after the trauma. Diagnosis can be made on clinical grounds alone and the passage of a catheter is condemned as clinically misleading and surgically dangerous. Partial rupture is relatively common and every effort should be made to preseve the remaining bridge of tissue which may still be viable. Initial treatment should ensure that no additional damage is done to the urethra by converting a partial rupture into a complete transection.