Search

Introduction: Penetrating neck trauma is a relatively rare though potentially devastating mode of injury. To date, there has been no analysis on this subject using the Trauma Audit and Research Network (TARN) dataset for the population of England, Wales and Northern Island. Methods: This was a retrospective observational study using the TARN dataset to identify all adult patients (≥16 years) presenting with neck trauma between January 2012 and March 2019. Results: A total of 2,395 patients met the inclusion criteria for this study: 1,584 with blunt injuries to the neck (374 isolated injuries) and 811 with penetrating neck injuries (412 isolated injuries). The median age of the study population was 44.2 years and 73% were male. The unadjusted mortality rate was 18.2%. Seventy-nine per cent of patients with penetrating injuries required surgical exploration. The odds ratios (ORs) of injury to the trachea, pharynx/retropharynx, jugular vein and larynx were all significantly increased with penetrating injuries to the neck. There was significantly increased mortality for those patients suffering hyoid bone injury (OR: 3.07, 95% confidence interval [CI]: 2.10–4.49), carotid artery injury (OR: 1.81, 95% CI: 1.41–2.32) and laryngeal injury (OR: 1.25, 95% CI: 0.95–1.65). Conclusions: Our data highlight the potentially devastating consequence of neck injury with associated injury patterns. Patients suffering penetrating neck trauma have complex care requirements needing appropriate specialty input. [ABSTRACT FROM AUTHOR]

While estimates of relative risks associated with risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, clinical questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. The European prospective investigation into cancer (EPIC)-Norfolk study included 25,311 participants (11,476 men) aged 4,079 years in 1993–1997. All participants were followed for osteoporotic fractures to March 2007. Ten-year absolute risk of fracture in men and women were calculated using the baseline survivor function in multivariable Cox proportional-hazards models adjusting for age, sex, history of fractures, body mass index, smoking, and alcohol intake. In comparison of those without history of fracture versus those with history of fracture, the 10-year absolute risk of any fracture in men ranged from 1.0 vs. 1.2% at age 40 years to 3.0 vs. 4.4% at age 75 years. The respective estimates in women ranged from 0.7 vs. 1.0% at age 40 years to 9.3 vs. 17.2% at age 75 years. Statistically significant interaction between age and sex was found ( P < 0.001), which contributed to the differences in predicted absolute fracture risks for men and women at different ages. Our study shows the need for population-specific data to develop efficient well calibrated algorithms for assessment of fracture risk. The interaction observed between sex and age points to the need for further prospective studies among men. [ABSTRACT FROM AUTHOR]

The purpose of this study was to design a clinically applicable classification for distal humeral fractures that would provide guidance to the surgeon with regard to surgical approach and operative management. The new classification was assessed by use of the original radiographs from a study comparing distal humeral fracture classifications undertaken in Oxford, England, and was validated by use of the exact methodology of that study. Nine independent assessors were asked to classify 33 sets of radiographs on 2 separate occasions using the classifications of Riseborough and Radin, Mehne and Jupiter, and the AO, as well as the new classification system. With the use of the κ statistic, the level of interobserver and intraobserver agreement was determined. The new classification system was found to be both substantially reliable (κ, 0.664) and reproducible (κ, 0.732). The new classification achieved superior interobserver and intraobserver agreement compared with the other 3 classification systems, with a low proportion of unclassifiable fractures. Used in conjunction with a management algorithm, we believe that the new classification aids the surgical decision-making process for these complex fractures. [Copyright &y& Elsevier]

Age-dependent cortical bone loss in adult females from a skeletal assemblage from 3rd-4th century AD England was studied using metacarpal radiogrammetry. Results showed reduced peak cortical bone thickness compared with modern subjects, and the magnitude of cortical bone loss in older females compared with their younger counterparts was greater than that documented for a modern reference population. An elevated prevalence of fractures classically associated with osteoporosis was also, observed in the over-50-year cohort. The severity of osteoporosis in this group is difficult to explain in terms of extraneous factors relating to 3rd-4th century lifestyles. Given the important genetic component in osteoporosis, the results may indicate some inherent susceptibility in this particular population to the disease, and ways in which this possibility might be further explored are suggested. [ABSTRACT FROM AUTHOR]

The physical demand of the modern game of cricket on the fast bowler is known to cause stress fractures of the lumbar spine. Between 1983 and 2001, we diagnosed pars interarticularis defects in 18 professional cricketers contracted to a single English County Cricket Club. Eight of these players were treated conservatively, with rest, supervised rehabilitation, bowling action analysis and re-education where necessary. The remaining 10 were treated operatively, 9 by Buck’s repair of the spondylolytic lesion. All 18 players returned to professional sport.We recommend treatment of this select group of sportsmen in a unit consisting of a specialist physiotherapist, a bowling coach and a spinal surgeon. Should conservative measures fail, we recommend Buck’s repair as the operation of choice. [Copyright &y& Elsevier]

Many factors may contribute to the mortality and morbidity following hip fracture, including the provision of care. We wished to examine the contribution of potential factors to in-hospital mortality, length of hospital stay and 90-day mortality by statistical analyses of an audit database of all hip fractures admitted to a teaching hospital following the introduction of a fast track admission system. In-hospital mortality was predicted by ASA grade, the presence of any complications, cardiovascular complications, grade of surgeon, operation type and shorter admission time, a measure of time taken to admit a patient to a hospital bed (P<0.001). Length of hospital stay was predicted by increased age, presence of chronic cognitive impairment/dementia, presence of an implant complication, operation type, fracture type and longer admission time, r=0.455, P<0.001. Ninety-day mortality was predicted by the presence of chronic cognitive impairment/dementia, cardiovascular complications, pulmonary complications, ASA grade, grade of surgeon and admission day, P<0.001. Rapid admission following a hip fracture may not be the ideal management approach for all patient groups. Further study is required to identify factors in the process of care which are associated with better outcomes. [Copyright &y& Elsevier]

Abstract: Anecdotal reports when a temporary ice-rink opened in Winchester, suggested a burden on the Emergency Department (ED) and Trauma & Orthopaedic (T&O) services. This study was undertaken to assess, prospectively, the workload created as a consequence of ice-rink injuries, when the facility was reopened over Christmas 2007. All patients attending from the ice-rink were included and their injuries reviewed. Costs of care were calculated based on ED attendance, out-patient appointments (OPA''s), radiography, plaster immobilisation and government tariffs for surgical procedures. The ice-rink was open for 39 days welcoming 43,000 skaters. Sixty-two accidents were recorded in the accident book, 43 attended the ED. Radiographic investigation was necessary for 31 patients. Nineteen had diagnoses of soft tissue injury, 3 of head/facial injuries. T&O received 23 referrals; all fractures were in the upper limb, 6 requiring admission and surgery. Fifty-eight ED, fracture clinic and physiotherapy OPA''s were required. Additional costs to The Royal Hampshire County Hospital (RHCH) were calculated as £33,718.50. This temporary facility created a smaller than predicted burden for the ED and T&O service, however, sufficient consideration of OPA requirements should be made when planning service provision whilst temporary recreational facilities, such as this, are open. [Copyright &y& Elsevier]

The article discusses research being done on the drop in post-fracture hip morbidity rates in Southern England. It references a study by Roberts and Goldacre in a 2003 issue of the "British Medical Journal." The positive benefits of improved internal fixation of the fracture are cited. Key findings from the epidemiological study are discussed.

The article reports on a study that suggests that drugs for gastric acid increase the risk of hip fractures. The medical records of 145,000 people in England who took proton pump inhibitors such as esomeprazole, lansoprazole and omeprazole for more than a year were studied. It was found that people taking those drugs had a 44% higher risk of hip fracture than those who did not. Earlier studies also showed that the drugs may decrease calcium absorption, which raises the risk of bone fracture.