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Aim: To investigate the epidemiological characteristics of patients with pelvic fractures. Material and Methods: We evaluated age, gender, comorbid disease, admission season, mechanisms of the injury, type of the fractures (Young Burgess classification), associated injuries, and mortality of patients with pelvic fractures in the emergency department (ED). Results: Of the 919 patients included in the study, 307 (33.4%) were female and 612 (66.6%) were male. The mean age was 36,5±14,82 (18-80) years. The mean age of males was 35.1 ± 13.63 years, and it was 39.2 ± 16.63 years for females. Of the males, 46.4% were in the 28-37 years range. Comorbid diseases were found in 254 (27.6%) patients. Of the patients, 302 (32.9%) were admitted in winter and 285 (31%) in summer. It was mostly occurred due to automobile accidents 268 (29.2%), followed by falls from height 211 (23%). Automobile accidents were most common in the winter season, while falls from height was more common in the summer. While automobile accidents, falls from height, motorcycle accidents were more common in males compared to females, falls from own height, pedestrians hit by a car, and other injuries were observed more frequently in females than males (p

Organised and non-organised sports have shifted greatly over the past decade with variations in epidemiological trends for maxillofacial trauma. Our aim is to describe epidemiological trends of sport-related facial fractures in adults outlining the differences amongst gender, age groups, types of sports, and how this impacts clinical outcomes and management. A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All sport-related facial fractures, aged 18 years and above, that attended or were referred to the unit were included in this study. Three hundred five sport participants presented with a facial fracture with a strong male predominance (7.5:1). Australian football league (AFL) was the most common sport (39.0%) to result in a facial fracture followed by cycling (13.1%). Younger men aged 18–45 years played AFL, whereas females aged 18–55 years engaged in cycling. Orbitozygomatic fractures were the most common facial fractures (33.1%). Associated injuries occurred in 6.9% of the cohort. There were significant differences between men and women for age, age groups, seasons, and type of sport (p

Background: In recent years, there is a success of Non-operative management of blunt liver trauma. Aim of Study: The aim of our study is to discuss our experience in Operative and Non-Operative management of Blunt liver Trauma. Patients and Methods: A prospective cohort enrolled twenty-seven patients with blunt liver trauma admitted to our hepato-biliary unit were managed with non-operative conservative management, Angioembolization or operative intervention. Results: The patients mean age was 31.1±7.51 years. Two (7.4%) patients were diabetic, three (11.1%) were hypertensive. Twenty-two (81.5%) patients Glasgow coma score >10. Twenty (74%) patients were managed Non-operatively. Nineteen (95%) patients had successful Non-operative management but one patient (5%)patient needed delayed operation. Seven (25.9%) patients were managed operatively. The most com-monly associated injury was chest (59.2%), head (33.3%), spleen (11.1 %) and kidney (3.7%). Liver related complications included biloma & pseudo-aneurysm. The overall mortality was (7.4%). Conclusion: NOM of blunt liver injuries in haemodynam-ically stable patients is safe and feasible. Haemodynamic instability, generalized peritonitis during resuscitation or associated intra-abdominal organ injuries requires early surgical intervention. Liver related complications contribute to failure of NOM. Associated extra-abdominal and intra-abdominal injuries do not interfere with non-operative management.v

Ramp lesions are important injuries that are difficult to detect on MRI and pose a challenge to diagnose on arthroscopy since they require inspection of the posteromedial compartment. No bony injury has been reported in the literature as an associated injury with the ramp lesion. We report a rare case of complete ramp tear of the posterior capsule-meniscal junction associated with fracture of the rim of the posterior medial tibial plateau and a double injury to the posterior medial meniscus forming a terrible triad with poor prognosis. This report has implications on the classifications of ramp lesions, posterior root injuries of the medial meniscus and meniscal tears as fracture of the rim adds a new dimension to these injuries.

Introduction Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia. Methods A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study. Results A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P Conclusions There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

Advancements in technology and the economic desires to maximize use of athletic playing surfaces have led to the development of various playing surfaces across the spectrum of sports. Each of these surfaces possesses specific safety profiles which are sport and population specific. Despite the growing medical literature on outdoor playing surfaces, inconsistent data exist on both orthopedic injuries and general medical concerns, such as surface component exposure toxicity and infection risk. Unfortunately, there is a paucity of data regarding various indoor playing surfaces and their effects on injury risk; this is an area ripe for further medical investigation. Understanding the differences in various play surfaces and their associated injury and health concerns is crucial for all medical staff providing care to athletes across the spectrum of skill and competition.

BACKGROUND Animal-related facial fractures can affect livelihoods impacting the hard and soft tissues of the face. Animal husbandry and recreational sports have close relationships with animals, which can lead to injuries equivalent to those of road traffic accidents and assaults. Our aim is to describe epidemiological trends of animal-related facial fractures in the paediatric and adult age group across South Australia. METHODS A retrospective review from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital in Adelaide. All animal-related injuries that attended or were referred to the unit were included in this study. RESULTS There were 50 patients who presented with an animal-related facial fracture. There was an equal distribution of males to females with horses as the most common animal to cause injury from kicking. The orbit and orbitozygomatic fracture equally represented the most common type of facial fracture with 38% of all cases having an associated injury. The operative rate was 56% with four post-operative complications. There were differences between males and females for season, post-operative complications and length of stay (P

The tackle is the in-game activity with the greatest risk for injury in collision sports. Qualitative match analysis has associated injury risk with tackle technique (e.g. tackle height, head position before contact). This exploratory study used gold-standard three-dimensional (3D) motion capture to investigate whether prior instructions to a tackler to execute different torso tackle types altered their tackle technique. Fifteen amateur-level rugby code players performed four sets of 10 tackle trials after instructions from an expert coach: two Australian National Rugby League (NRL) coaching manual instructions on upper and lower torso tackle height (UpperNRL, LowerNRL); and two novel variants that altered the tackler’s contact with the ball carrier’s upper torso ( UpperPop) via a vertical ‘pop action’, or mid-torso ( MidTorso) via increasing the contact height to the mid-torso. 3 D motion capture confirmed a favourable ‘head up and forward’ gaze focus on ball carrier before contact and a ‘straight back’ posture was more evident in UpperPop instruction than other instructions, with the least flexion for the head, trunk, trunk-pelvis, thoracolumbar and lumbopelvic (p

Introduction: One of the challenging tasks for drivers is the ability to change lanes around large commercial motor vehicles. Lane changing is often characterized by speed, and crashes that occur due to unsafe lane changes can have serious consequences. Considering the economic importance of commercial trucks, ensuring the safety, security, and resilience of freight transportation is of paramount concern to the United States Department of Transportation and other stakeholders. Method: In this study, a mixed (random parameters) logit model was developed to better understand the relationship between crash factors and associated injury severities of commercial vehicle crashes involving lane change on interstate highways. The study was based on 2009–2016 crash data from Alabama. Results: Preliminary data analysis showed that about 4% of the observed crashes were major injury crashes and drivers of commercial motor vehicles were at-fault in more than half of the crashes. Acknowledging potential crash data limitations, the model estimation results reveal that there is increased probability of major injury when lane change crashes occurred on dark unlit portions of interstates and involve older drivers, at-fault commercial vehicle drivers, and female drivers. The results further show that lane change crashes that occurred on interstates with higher number of travel lanes were less likely to have major injury outcomes. Practical Applications: These findings can help policy makers and state transportation agencies increase awareness on the hazards of changing lanes in the immediate vicinity and driving in the blind spots of large commercial motor vehicles. Additionally, law enforcement efforts may be intensified during times and locations of increased unsafe lane changing activities. These findings may also be useful in commercial vehicle driver training and driver licensing programs.

Diabetes associated injury healing and other tissue irregularities are viewed as a significant concern. The purpose of the study is to design the wound regeneration activity of Ficus carica extract (FFE) loaded amphiphilic polymeric scaffold of poly(xylitol-g-adipate-co-glutamide) (PXAG)–polyhydroxybutyrate (PHB) for potential diabetic affected wound regeneration. The PXAG copolymer was prepared by the condensation method, and the polymeric scaffolds of PXAG-PHB, PXAG-PHB/FFE were developed through the ultra-sonication process and magnetic stirrer processes. The chemical structure, crystalline nature, thermal stability, size, surface charge and surface morphology of PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds were investigated. The PXAG-PHB/FFE exhibits 99.0% free radical scavenging activity which was determined by the DPPH method. The inhibition zones by the PXAG-PHB/FFE indicate it had a higher antibacterial activity with the Escherichia coli (gram-negative) and Staphylococcus aureus (gram-positive) pathogens. The PXAG, PXAG-PHB and PXAG-PHB/FFE polymeric scaffolds exhibited good viability against diabetic induced wound cells (WS1) in 100 μg/mL concentrations up to 72 h incubation. Since the synthesized PXAG-PHB/FFE polymeric scaffolds possess excellent thermal stability, bioactivity, biocompatibility and antioxidant activity along with potent antimicrobial activity, they play a potential role in diabetic wound tissue regenerations.

Objectives: We determined the Outcome of subaxial cervical injury management in adults through anterior approach open reduction and fixation injury < 72 hours. Material and Methods: A total of 71 patients declared to have a recent chronicle of traumatic cervical spine injury with a conventional diagnosis of subaxial injury by Magnetic Resonance Imaging (MRI) and X-Ray anteroposterior and lateral views. ASIA Impairment Scale was used for assessment and was done at the time of admission and after six months. Results: Mean age of the patients in our study was 38.54 ± 5.47 years. According to American Spinal Injury Association (ASIA) scale, improvement by two grades was seen in 18 cases and improvement by one – grade was observed in 48 cases. Mortality was seen in 5 cases, where 2 deaths were related to associated injury, one related to a complication of surgery and other 2 died due to aspiration complications. Out of 66 cases, the outcome was good in 49 (74.29%) and fair in 17 (25.76%). Conclusion: The study results revealed that Anterior Cervical Discectomy and Fusion (ACDF) is considered to be a better treatment choice for better anatomical stabilization of the spine with early reduction. Keywords: Subaxial cervical injury, anterior approach, ASIA (American Spinal Injury Association) scoring.

Background: Maxillofacial region is a complex anatomical region that is commonly injured due to trauma and Multidetector Computed Tomography and Three-Dimensional Computed Tomography are used for accurate assessment of fractures and associated soft tissue injuries for correct clinical management. The objective of this study was to determine the frequency, various types of maxillofacial fractures and associated injuries using MDCT and 3D computed tomography (3D CT) at Sharif Medical City Hospital, Lahore. Patients and methods: This was a cross-sectional study, carried out in the Department of Diagnostic Radiology, Sharif Medical City hospital, Lahore from December 2018 to November 2019. 3D reconstructed CT images were obtained in 70 patients with maxillofacial injuries referred to the Radiology Department of Sharif Medical City Hospital, using 16 slices Toshiba® Aquillion Multidetector Computed Tomography scanner. CT images were evaluated by consultant radiologists and data was collected. Results: The maxillofacial fractures were significantly higher in the male population 61 (87%) than the female population 9 (13%). Road traffic accidents were the most common cause of injury and the mean age was 30±12 years with the most common age group were 21-30 years (32.8%). Maxilla and maxillary sinus wall fracture were commonest fracture 23 (33%) followed by orbital 20 (28%) bone fractures. Hemosinus 22 (31.4%) was the commonest associated injury. Conclusion: The complex anatomy of the facial bones requires MDCT and 3D CT which offers excellent spatial resolution, and helpful in the accurate diagnosis of the maxillofacial fractures their exact site, number, and associated injuries, and surgical planning.

Background and importance Retraction injury can result in significant complications during intracranial operations. Alternative surgical techniques to minimize retraction pressure and duration of retraction can minimize the risk of retraction injury. We describe the use of a cottonoid "slider," which is a simple, cost-effective modification of a commonly used cottonoid, in multiple applications. Clinical presentation The cottonoid sliders are constructed preoperatively by overlaying an adhesive plastic incision drape on one side of a dry cottonoid patty and trimming the edges to fit the form of the cottonoid. Intraoperatively, the sliders can slide across the parenchymal surface atraumatically and are used for gentle retraction to expose desired areas. In addition, suction may be placed on the slider to clear fluid from the operative view. The plastic side of the slider prevents adherence to the parenchymal surface. Retractorless surgical techniques have been developed to minimize risk of retractor associated injury in intracranial surgery by reducing retraction pressure and duration. Given that the cottonoid sliders glide along the parenchyma, do not stick, and are used for dynamic retraction, the main objectives to minimize retraction injury can be met while not compromising operative efficiency. Conclusion Cottonoid sliders are a simple and cost-effective method of providing gentle exposure during intracranial surgery. This technique represents a valuable and cost-effective addition to the neurosurgical armamentarium.

Patients with equine-related injuries (ERI) have high rates of hospitalization and often require surgical treatment. This study aimed to clarify the injury profiles of patients sustaining ERI-related craniofacial fractures and their relationship with other severe head and neck injuries. This retrospective study included all patients with craniofacial fractures admitted to a tertiary trauma center during 2013 to 2018. Out of 3256 patients, a total of 39 patients were included in the study (1.2%). Demographic and clinically relevant variables were reported and statistically evaluated. Males represented only 7.7% of the study population. Isolated facial fractures were over-represented in this study population at 84.6% whereas only 7.7% of patients sustained isolated cranial fractures and 7.7% of patients sustained combined craniofacial fractures, respectively. Surgical intervention for craniofacial fractures was required in 48.7% of patients. In total, 17.9% of patients sustained severe head and neck injuries. Periods of unconsciousness and/or post-traumatic amnesia were seen in 41% of patients. Helmet use could only be confirmed in 17.9% of patients. As trauma mechanisms behind ERI are often multifactorial and patients are at a high risk of sustaining associated injuries, attentive examination, and exclusion of serious life-threatening injuries through a multi-disciplinary approach is imperative for this specific patient population.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

Spine surgeons often confuse C2 pedicle fractures (PFs) with pars interarticularis fractures. In addition, little information is available about the characteristics and treatment strategies for C2 PFs. We sought to investigate the characteristics of C2 PFs and to propose an appropriate treatment strategy. A total of forty-nine patients with C2 PFs were included in this study. We divided these patients into unilateral and bilateral C2 PF groups. The incidence rates and characteristics of other associated C2 and C2-3 injuries, and other cervical injuries, were evaluated. In addition, treatment methods and outcomes were analyzed. Twenty-two patients had unilateral C2 PFs and twenty-seven patients had bilateral C2 PFs. Among the cases of unilateral C2 PFs, all patients had one or more other C2 fractures, and twenty patients (90.9%) had one or two C2 body fractures. Meanwhile, among the cases of bilateral C2 PF, all patients had two or more other C2 fractures and one or two C2 body fractures. In unilateral C2 PFs, three patients with C2-3 anterior slip or adjacent cervical spine (C1-3) injury underwent surgery and nineteen patients (86.4%) were treated with conservative methods. In bilateral C2 PFs, three patients with C2-3 anterior slip or SCI at C2-3 underwent surgery and twenty-four patients (88.9%) were treated with conservative methods. Our results showed that C2 PFs do not occur alone and are always accompanied by other associated C2 injuries. C2 PFs should, generally, be thought of as a more complex fracture type than hangman’s fracture or dens fracture. Despite the complex fracture characteristics, most C2 PFs can be managed with conservative treatment. However, surgical treatments should be considered if the C2 PFs are accompanied by the C2-3 anterior slip and adjacent cervical spine injury.

STUDY DESIGN: Hospital-based retrospective epidemiological research. OBJECTIVES: To describe the epidemiological and demographic features of patients with traumatic cervical spinal cord injury in Chongqing, China from 2009 to 2018. SETTING: Army Military Medical University Xinqiao Hospital in Chongqing. METHODS: All patients diagnosed traumatic CSCI admitted to Xinqiao hospital from 2009 to 2018 were retrospectively reviewed. Data elements referred from the International SCI Core Data Set, included date of birth, date of injury, gender, etiology of injury, vertebral injury, associated injury, ventilatory assistance, and neurological status were collected. RESULTS: A total of 503 patients with TCSCI met the criteria. The mean age of patients with TCSCI was 50.3 ± 13.9 years (15–85 years), and the male-to-female ratio was 4.7:1. Fall (67.2%) was the leading cause of injury, followed by transport (22.3%). The most common neurologic level of injury (NLI) was C5, accounting for 38.2%. The number of AIS D was the largest, accounting for 42%. CONCLUSIONS: The results indicated that TCSCI occurred most frequently in the middle age and fall was the leading cause of injury. The number of patients with TCSCI was larger in male than in female. The most common NLI occurred in C5, and AIS D had the largest numbers.

Objective The AOSpine Subaxial Cervical Spine Injury Classification System was introduced to improve communication, clinical management, and research. Here, the system was studied in relation to injury severity along with admission and long term neurologic follow-up. Methods A retrospective study was performed in subaxial cervical spine injury patients. Morphology was classified using the AOSpine Subaxial Cervical Spine Injury Classification System. Six major morphology subtypes were selected for analysis. The American Spinal Injury Association (ASIA) motor and Abbreviated Injury Severity (AIS) scores were recorded at admission and at follow-up >6 months. Admission intramedullary lesion length (IMLL) on MRI was recorded. Results In all, 82 patients met criteria for analysis. The mean follow-up time was 11 months (range, 6–33 months). The were 36 patients with morphology subtypes A0, 4 with A1/A2, 9 with A3/A4, 8 with B2, 11 with B3, and 14 with C. The A1/2 subtype had the least severe injuries on admission. The C and A3/A4 subtypes had the most severe injuries. The subtype C had the lowest ASIA Motor Score (AMS) and second highest percentage of complete injuries. A3/A4 patients had the highest percentage of complete injuries on admission. At follow-up, A3/A4 patients had the lowest AMS, and 33% of patients continued to have complete injuries. C subtype injuries all converted to AIS incomplete injuries on follow-up (P = 0.04). IMLL was found to be significantly different compared across multiple morphologic subtypes. Surgical management for each morphology subtype was reported. Conclusion The AOSpine Subaxial Cervical Spine Injury Classification System successfully associated injury morphology with IMLL along with admission and long-term neurologic function and recovery.

BACKGROUND The purpose of this study was to evaluate the clinical outcomes of isolated decompression for patients with transverse sacral fractures and cauda equina syndrome, which have been rarely reported before. MATERIAL AND METHODS Twelve neurological impaired patients with transverse sacral fracture from January 2010 to March 2017 treated in our institution were evaluated. All patients went through isolated decompression and were followed for a minimum of 12 months. Fracture causes, classifications, associated injury, radiologic results, clinical outcomes using the Majeed index, and neurological outcomes using the Gibbons criteria were evaluated. RESULTS Motor vehicle accidents and falling injuries were the major causes of trauma. The average time from trauma to surgery was 89.8 days. Eleven patients underwent laminectomy with no more than 3 segments resected and 1 patient had S1-S4 excised. Three patients with fracture involving the lumbopelvic joint had L5 laminectomy. All patients achieved bony union, with 7 patients (63.6%) showing satisfactory pelvic outcome. Average Gibbons scores improved from 2.8 to 1.9 at 18-month average follow-up, but most patients were left with residual pain. No surgical-related complications were seen in any patients. CONCLUSIONS Isolated decompression can be considered for patients who present a stable sacrum with non-displaced fracture or an old fracture that shows fracture healing. Favorable pelvic outcomes and neurological recovery, along with acceptable stability, can be acquired.

Objectives: To evaluate the efficacy of Decompressive Craniectomy (DC) on the postoperative clinical state of the patient to define a line of management of these cases. Take in considerations the surrounding circumstances of the patient till he reaches the ER in Egypt and the hospital resources. Methods: 200 patients suffering from acute traumatic brain injury causing DCL resulted from different pathologies causing increased ICP. In group A, patients with acute TBI were managed by surgical intervention in the form of Decompressive Craniectomy and in the control group B, patients were managed by medical treatment. The age range was from 8 to 65 with no history of associated medical disorders with exclusion criteria of non-traumatic causes of increased ICP. Results: Data collected showed: male to female ratio of 3:1. The most common mode of injury was falling from height. Mean time from injury to operative intervention was 4 hours. The leading initial symptoms were DCL. In group A the overall mortality was 60%, functional recovery rate was 30%, and left severely disabled or vegetative was 10%. 50% of the cases had associated injury. 20% suffered from post-operative complications. Conclusion: DC is the ideal solution for the management of acute TBI with persistent increased ICP when the other medical management fails, given an early intervention and taking into consideration other factors affecting surgical outcome.

Renal segmental metabolism is reflected by the complex distribution of the main energy pathways along the nephron, with fatty acid oxidation preferentially used in the cortex area. Ischemia/reperfusion injury (IRI) is due to the restriction of renal blood flow, rapidly leading to a metabolic switch toward anaerobic conditions. Subsequent unbalance between energy demand and oxygen/nutrient delivery compromises kidney cell functions, resulting in a complex inflammatory cascade including the production of reactive oxygen species (ROS). Renal IRI especially involves lipid accumulation. Lipid peroxidation is one of the major events of ROS-associated tissue injury. Here, we briefly review the current knowledge of renal cell lipid metabolism in normal and ischemic conditions. Next, we focus on renal lipid-associated injury, with emphasis on its mechanisms and consequences during the course of IRI. Finally, we discuss preclinical observations aiming at preventing and/or attenuating lipid-associated IRI.

Background Recreation for children with living with Autism Spectrum Disorder (ASD) is important for improving health and quality of life, however, children with ASD and their families experience many barriers to activity participation. Child elopement behavior is a key barrier that poses a safety concern for parents and is associated with injury occurrence. Methods We conducted a scoping review, guided by Arksey and O’Malley’s framework, to assess the literature on elopement among children with ASD. Search procedures were developed in consultation with university librarian and included searches of five data bases, grey literature, and hand-searching. Included articles were those addressing elopement among children 0–19 years with ASD. Abstracts and full text articles were assessed by two reviewers and a third reviewer arbitrated disagreements. Results A summary of search procedures and key study findings will be presented. Key findings pertain to: nature and patterns of elopement behavior and associated injury outcomes, factors associated with elopement behavior, and preventive intervention approaches and outcomes. Conclusion This assessment of current literature promotes understanding of elopement behavior among children with ASD, related factors and preventive approaches. This research supports SDG #10 for reduced inequalities through better understanding of elopement to inform strategies for promoting inclusive and safe recreation participation for children with ASD. Learning Outcomes Participants will gain understanding of elopement as a safety issue and barrier to equitable recreation participation for children with ASD. Participants will gain knowledge of current research findings about elopement and its prevention.

Although pediatric lower limb shaft fractures are common, little is known about associated injuries. The purpose of this study was to examine associated injuries complicated by pediatric lower limb shaft fractures and the efficacy of surgical treatment using a flexible stainless-steel intramedullary Ender nail in children less than 15 years old. This is a retrospective review of 29 children younger than 15 years old who were diagnosed with femoral or tibial shaft fractures and treated using Ender nails from 2005 to 2016. Baseline data, etiology, associated injuries, fracture site and patterns, operative and post-operative assessment were evaluated. The average age of the patients was 9.0 years, and mean follow-up was 18.2 months. Eleven patients (79%) had associated injury. At the final follow up, six patients (43%) sustained complications associated with the insertion area of the nail. There was no evidence of deep infection or nonunion at either fracture site. The clinical results were excellent in 10 (67%) fractures, and good in 5 (33%) fractures, based on the modified Flynn criteria. Almost all patients with a femoral fracture had an associated injury including abdominal visceral injury, cerebral contusion or other fractures. This study indicated good clinical and functional outcomes. On the other hand, the minor complications rate was high. Nevertheless, elastic stable intramedullary nailing recently has become available in Japan, and a prospective and comparative study is needed.

Background Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%) . A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

Delayed recognition of compartment syndrome can result in devastating consequences such as the need for amputation or even death. Nurses are at the frontline of patient care in the orthopedic department and it is essential that they have a high index of suspicion for compartment syndrome. In this publication we describe an easily replicable project to assess and improve the understanding of the condition by nurses on trauma wards. Our project involved a questionnaire to assess the ability of nurses to recognise the key clinical features of compartment syndrome. This initial questionnaire was followed by a one-week teaching programme within the department, after which the questionnaire was repeated. Our results demonstrate that nursing staff place a disproportionate emphasis on neurovascular compromise in recognising the condition. Only just over one half (11/21) could correctly identify 'pain out of proportion to the associated injury' as the key clinical feature. Unlike pain, neurovascular compromise is a late feature of compartment syndrome and overstating its importance may potentially contribute to delayed diagnosis. Our targeted educational week dramatically improved the number of correct responses. One month after the teaching week, 83% (19/23) of nurses correctly identified pain as the most important feature in compartment syndrome. We hope that improved knowledge of compartment syndrome by nurses will help to reduce delayed recognition and adverse outcomes.

Background: The Major League Baseball (MLB) All-Star Game (ASG) Home Run Derby (HRD) remains a highly anticipated event, during which contestants can take hundreds of maximum-effort swings en route to hitting a multitude of home runs. Critics have openly questioned the risk-benefit of HRD participation as it pertains to injury, alterations in swing mechanics, and timing. Purpose: To determine whether participation in the MLB ASG HRD was associated with both increased injury risk and decline in second-half performance in MLB players. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players who participated in the HRD between 2006 and 2019 were identified through publicly available internet databases. A control group of ASG participants who had the highest home run totals in the first half of the corresponding MLB season were selected as a control group. Multivariable linear regression was used to determine independent associations between HRD participation and batting metrics in the second half of the season. Multivariable logistic regression also assessed the impact of HRD participation on injured list placement during the second half of the concurrent MLB season. Results: A total of 114 HRD participants and 114 ASG participant controls competed during the study period. No statistically significant differences were seen in batting metrics in the second half of the MLB season between HRD participants and ASG controls, although HRD participants had a significantly lower wins-above-replacement statistic for the season compared with controls (4.69 ± 2.06 vs 5.33 ± 2.08; P = .021). HRD participation was not significantly associated with injury during the second half. The number of HRD rounds in which a player participated did not result in a statistically significant increased odds of injury during the second half of the MLB season. Conclusion: HRD participants did not have increased odds of being placed on the injured list during the second half of the MLB season compared with controls, nor did they experience second-half performance declines in offensive production versus controls when multivariable linear regression analysis was performed.

Objectives The aim of this study was to describe the self-reported injury, training, and running technique choices of regular runners in four international regions. Design and setting 756 participants began an expert derived self-report online survey in Ireland, USA, Hong Kong and Australia. Participants 325 participants completed the survey (age = 38 ± 10 years; weight = 68.0 ± 13.1 kg; height = 1.70 ± 0.10 m). Main outcome measures Descriptive statistics are reported examining injury incidence and location; shoe and orthosis choices; and training and technique practices. A backwards logistic regression was implemented to examine associations between injury and training choices. Results 68.3% reported having an injury in the last year. 81.45% of these injuries were believed to be running related. A large variation in training and footwear choices were observed for respondents. The regression (P ≤ 0.001) explained 20% of the variance in injury selection (Nagelkerke R2) and was able to identify 73% of cases accurately. Associated injury factors included competitive running, running on more than one surface, younger age, having a lower running age, and a higher proportion of running at an easy intensity. Conclusions The high amount of variability in runner’s choices highlights the lack of consistent information being presented to them and may be the reason for the high injury incidence.

We clarified occurrence, severity, and associated injuries of occipital condyle fractures (OCFs) in a cranial fracture population. Retrospective data of cranial fracture patients were analyzed. The outcome variable was presence of OCF in cranial fracture patients. Predictor variables were type of associated injury, Glasgow Coma Scale (GCS) value under 6, and death during hospital care. In addition, occurrence of OCF was assessed according to cranial fracture subtypes. Explanatory variables were age, sex, injury mechanism, involvement of alcohol, and high-energy injury. Treatment and outcome of OCFs were analyzed. Of 637 cranial fracture patients, 19 (3.0%) sustained an OCF, eight of whom had no other cranial fractures. In the multivariate adjusted model, increased risk for OCF was detected in patients with cervical injuries (OR 18.66, 95% CI 5.52, 63.12; p < 0.001) and facial fractures (OR 5.99, 95% CI 1.01, 35.45; p = 0.049). Patients with fractures not extending to the skull base were less likely to have OCF (OR 0.01, 95% CI 0.001, 0.25; p = 0.004), and fractures localized solely to the base of the skull offered a protective effect for OCF (OR 0.19, 95% CI 0.06, 0.58; p = 0.003). All OCFs were treated non-operatively with a cervical collar without complications. OCF patients typically sustain other severe injuries, particularly cervical injuries and facial fractures. Careful screening for associated injuries is therefore crucial when examining a patient with OCF. The classification scheme of Mueller et al. seems to be useful in guiding the treatment of OCFs, at least type 1 and 2 fractures. (C) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A four-year-old male restrained passenger in the rear seat was in a motor vehicle collision. He had pain and swelling in the tip of the penis with the inability to micturate. The patient on evaluation had an isolated injury of the prepuce. The patient underwent an evaluation to rule out underlying penile/urethra and associated injury of kidney and bladder. The patient had an isolated injury to prepuce, causing urinary retention for which he underwent circumcision.

Objective The aim of this study was to report a case of cochlear implantation (CI) for a patient with an otic capsule-sparing traumatic brain injury (TBI) and to review the relevant literature. Methods A patient with history of TBI received a CI for bilateral profound hearing loss. A systematic review of the literature was performed to identify and compare similar cases. Results A 36-year-old male with a history of hearing loss from right acute labyrinthitis was referred for bilateral profound sensorineural hearing loss (SNHL) after a fall with associated injury to the central auditory nervous system (CANS) including the brainstem. On the right, behavioral acoustic threshold measurements were in the profound range with absent OAEs. On the left, testing revealed no measurable behavioral acoustic thresholds and variable physiologic measures. A right unilateral cochlear implant was performed with most recent follow-up demonstrating speech awareness thresholds of 25 dB HL with excellent detection of all 6 Ling sounds. However, the patient also continues to suffer from other neurologic sequelae related to his TBI, which challenge his ability to demonstrate objective and subjective benefit. A systematic review of the literature demonstrates variable outcomes for patients with TBI and SNHL. Conclusions Patients with profound SNHL and TBI present a distinct rehabilitative challenge for clinicians. CI may provide meaningful benefit in this population, though care should be taken in patient selection and counseling.