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The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries. [ABSTRACT FROM AUTHOR]

Post-mortem computed tomography (PMCT) is routinely used at many forensic institutions to guide the following autopsy and is especially useful for diagnosing fractures. This systematic review aims to investigate the sensitivity and specificity of a PMCT scan in fracture diagnosis of the hyoid-larynx complex (HLC) compared to traditional autopsy in cases involving traumatic neck injuries. We searched PubMed, SCOPUS and Web of Science and included papers with cases n ≥ 3 published between January 2000 and April 2023 reporting on PMCT and autopsy findings of fractures of the HLC. The search provided 259 results of which 10 were included. Overall sensitivity and specificity were 0.70 [0.59; 0.79] and 0.92 [0.80; 0.97] for hyoid bone fractures and 0.80 [0.62; 0.91] and 0.76 [0.63; 0.85] for the thyroid cartilage. The results show great variation, and a large range between studies. These results indicate that PMCT cannot replace autopsy in cases with HLC fractures. Future larger prospective studies are needed, examining fracture details, scan protocols and different slice thicknesses using uniform reporting. [ABSTRACT FROM AUTHOR]

The digitalization has developed in all economic spheres.Working with a video display has undeniable advantages in today's world of global changes, but it is associated with certain health risks in connection with the strain on the musculoskeletal system and the visual analyser. This could lead the occurrence of stressful situations, the accumulation of fatigue and an increase in the number of errors at work. Maintaining the head and back in a fixed position, static loading, performing rapid high-tempo movements (repetitive activity), hand positioning, bending and twisting of the body during work are some of the causes of musculoskeletal injuries in the neck, back and lower back, numbness of the fingers. Prolonged work with a video display results in burning, dry or watery eyes, blurred vision,etc. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to review whether legislative change enforcing safer riding conditions for Electric Scooters (E‐Scooter), regardless of other factors, had an impact on reducing significant head, facial and neck trauma. Additionally, to identify the radiological injury patterns for head, face and neck injuries identified on CT imaging for a patient's initial presentation to the emergency department (ED) resulting from an E‐Scooter accident. Methods: A retrospective single‐centre observational study at a metropolitan tertiary ED of patients presenting after an E‐Scooter accident comparing 6 months before and after legislative change. Results: Four hundred and forty‐three patients presented following an E‐Scooter accident: 191 patients 6 months before and 252 patients 6 months after legislative change. One hundred and sixty‐two patients pre‐ and 217 patients post‐legislative change had negative CT studies. Twenty‐nine patients pre‐ and 35 patients post‐legislative change had CT studies demonstrating significant head, face or neck trauma. The most common type of intracranial bleeding was subarachnoid haemorrhage followed by subdural haemorrhage with a significant proportion (41%) presenting with multi‐factorial intracranial bleeding. There was no specific injury pattern involving the cranial vault or cervical spine. Of the patients presenting with a significant injury, facial bones were the most common injury site (84% (n = 54)). The most common site of facial fractures was the nasal bones followed by dental trauma and maxillary fractures. Conclusion: This single‐centre, retrospective observational study has shown no reduction in serious head, neck and facial injuries. Large‐scale, multicentre studies will need to be undertaken to understand the true impact of legislative change. [ABSTRACT FROM AUTHOR]

Trauma to the neck can produce catastrophic results as neck houses plethora of vital structures and is relatively an unprotected anatomical territory. Blunt trauma to the neck, excluding cervical spine injuries, represents only 5% of all neck trauma, but can be very challenging to assess since its presentation is often delayed. Penetrating injuries, on the other hand, are more common, and even when they seem to be only superficial and minor, always need thorough investigation and observation. Primary stabilization of the patient followed by an extensive evaluation needs to be done in all cases of neck trauma. CECT neck and thorax along with fibreoptic laryngoscopy remain the main modalities of diagnosis following a neck trauma. The initial approach to any kind of neck injury, whether penetrating or blunt, is performed according current Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC) protocols, which both use the structured 'ABCD' approach. A motor vehicle accident (MVA) remains the most common cause of blunt neck injury, causing direct pressure to the anterior neck from the dashboard, steering wheel or airbag deployment. Direct pressure to the neck is transduced to the trachea and causes compression of the oesophagus against the cervical spine. Laryngotracheal trauma continues to be a rare entity and is the second most common cause of death in patients with head and neck trauma after intracranial injury. Only 0.5% of multiple trauma patients were reported to have injury to the airway at any level. Stabilize the airway first. Immediate surgical airway procedure can be necessary in less familiar circumstances and environments. If possible, define landmarks before the procedure. Defining anatomical zones is useful in penetrating injuries, although these do not guide diagnostic or therapeutic management completely. In unstable patients, elective surgical exploration is recommended instead of extensive diagnostic work-up. Unstable patients still need immediate exploration, whereas all stable patients will first be assessed with clinical examination and CT angiography and fibreoptic laryngoscopy. Thus the take home message is to consider all neck injuries an emergency and proceed with the diagnosis and management without delay. [ABSTRACT FROM AUTHOR]

Powered scooters, including electric scooters (e-scooters), have become an increasingly available and popular mode of personal transportation, but the health risks of these devices are poorly explored. We aim to quantify the increase in frequency of powered scooter–associated head and neck region injuries occurring yearly from 2010 to 2019, and to compare the frequency and severity of injury with those involving unpowered scooters. Here we present a retrospective cross-sectional study of all patients with head and neck injuries associated with powered and unpowered scooters seen in emergency departments reporting to the National Electronic Injury Surveillance System (NEISS) database from January 1, 2010 to December 31, 2019. During this time frame, a total of 1,620 injuries associated with powered scooters and a total of 5,675 injuries associated with unpowered scooters were reported to the NEISS. The database estimates these to reflect a nationwide total of 54,036 powered scooter–related injuries and 168,265 unpowered scooter–related injuries. Powered scooter injuries have increased for both children and adults since 2014, and estimated powered scooter injuries (16,243) surpassed estimated unpowered scooter injuries (14,124) when including all age groups for the first time in 2019. In 2019, adults are estimated to have nearly twice as many powered scooter–related head and neck injuries as children (10,884 vs. 5,359, respectively). In 2019, a higher proportion of powered scooter–related injuries involving adults were severe injuries when compared with those involving children (13.3 vs. 5.2%, respectively). Interestingly, unpowered scooters still cause many more estimated injuries in children than powered scooters did during 2019 (11,953 vs. 5,083). We find that powered scooters are now associated with a greater number and severity of head and neck injuries among the adult population than the pediatric population. But unpowered scooters still cause more head and neck injuries than powered scooters in the pediatric population. [ABSTRACT FROM AUTHOR]

Strangulation by ligature is often homicidal and is mainly diagnosed through the detection of a ligature mark on the neck. We describe the unusual appearance of a ligature mark in a woman who was strangled and thrown into a river, where she lay for one month. On her neck, there was an irregular horizontal tear, associated with superficial ecchymosis and deep structures' haemorrhage. We made a comparison with literature cases of unusual features of the ligature mark. The ligature mark appearance can be influenced by post-mortem modifications, effects of concealment methods, cut injuries and neck tightening resulting in decapitation. Drowning victims could show injuries similar to those resulting from hanging/strangulation. We found just a few cases of water immersion after strangulation and no cases of a ligature mark presenting like a loss of substance. We tried to explain the unusual appearance of the ligature mark in our case: the skin at the ligature mark lost the superficial layer and underwent dehydration, so soaking and maceration have been accelerated and produced the appearance of loss of substance. Finally, the study led to the distinction from other sources of traumatic action and the definition of the cause of death. [ABSTRACT FROM AUTHOR]

One in three patients admitted to intensive care will sustain a pressure injury (PI) from a medical device. These injuries are painful and when on the face, head or neck they can result in permanent disfigurement. Preliminary evidence of the efficacy of hyper‐oxygenated fatty acids (HOFAs) to prevent facial pressure injuries from medical devices is promising; however, the feasibility of incorporating HOFAs into current standard care to prevent PI from a medical device of the face, head and neck has not been extensively explored. It is intended that the findings from this phase II feasibility study will inform the design of a larger phase III trial, by addressing two primary aims: (1) to assess the feasibility of incorporating HOFAs into standard care to prevent device‐related pressure ulcers of the skin associated with the face, head and neck assess the feasibility and (2) efficacy preliminary effectiveness of HOFA. This feasibility study is an investigator‐initiated mixed method study incorporating a multi‐centre randomised controlled trial of using HOFAs as an adjunct to standard pressure injury prevention and care, compared with standard care alone to prevent facial, head or neck from medical devices among adults admitted to intensive care. The primary outcome of interest is the incidence of facial, head or neck pressure injuries during the first 14 days in intensive care. Secondary outcomes include PI staging, medical device exposure and intensive care and hospital outcomes. The primary analysis will be undertaken using Cox's Proportional Hazards model, and due to the exploratory nature of this phase II trial, efficacy will be based on a one‐sided p‐value for superiority set at 0.10. Type I and Type II error rates are set at 20%; therefore, a total sample size of 196 study participants is planned. To explore the feasibility of incorporating HOFA into usual care and to design a larger phase III trial, we will aim to interview between 10 and 20 nurses across participating intensive care unit sites. Pressure injuries of the face, head or neck from medical devices, among adults admitted to intensive care, are considered preventable. This phase II study will investigate the feasibility and efficacy of HOFAs as an adjunct to standard care. Importantly, we aim to inform the development of a larger phase III trial. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSIs) pose a significant problem for active duty service members (ADSMs). MSIs may compromise readiness and are one of the main reasons for separation from the Navy and long-term disability. Implementation of optimal treatment strategies rests on understanding the characteristics of MSI complaints in a given population. This study reports on the frequency and nature of MSI complaints of ADSMs seeking care at a military treatment facility (MTF). Materials and Methods As part of a larger quasi-experimental study, data on MSIs from ADSMs reporting to an MTF were collected. Subjects completed a baseline questionnaire during an initial evaluation, including the self-reported MSIs for which participants were seeking care, time since onset, and other MSI comorbidities. Results Of the 289 respondents, 118 (41%) were female and 172 (59%) were male. The mean age was 33 years (SD = 8). The most frequently reported injury was low-back pain (n  = 79, 27%), followed by knee pain (n  = 60, 21%) and shoulder pain (n  = 55, 19%). Thirty-four (12%) respondents reported injuries to the ankle or foot. The remaining respondents (21%) reported injuries to the neck, mid-back, arm or hand, hip, or other. Sixty-five (22%) reported an acute/subacute injury of less than 3 months, whereas 224 (78%) reported chronic injury >3 months. Furthermore, MSI comorbidities were reported by 233 (80%) of respondents with 128 of those reporting more than one. Conclusions Back and knee injuries were most prevalent in ADSMs reporting an MSI at a Navy shore-based MTF. Shoulder injuries were also common. Of interest, 80% of ADSMs reported at least one MSI comorbidity and 80% reported chronic injury in this study. These rates are higher than those found in a previous study of ADSMs deployed on a carrier. This is notable because chronicity and multiple MSIs are obstacles to readiness. Our findings suggest that ADSMs reporting to shore-based facilities may be at higher risk for disability than their deployed counterparts. This information is important to the development of targeted care to improve readiness in this population. [ABSTRACT FROM AUTHOR]

Traumatic hemorrhage of the thyroid gland resulting from blunt injury to the neck is a very rare event. Particular neck positions can expose the thyroid to trauma, especially in motor vehicle collisions, falls, direct blows, or sport activities. Preexisting conditions such as goiters, adenomas, and cysts can increase the risk of bleeding, reducing the force required to rupture the gland and make the thyroid more prone to injury. The authors report the case of a 53-year-old man who was involved in a fire while working on maintenance of a liquid petroleum gas (LPG)–powered car. He subsequently presented to the emergency department with painful swelling of his right anterior neck with a palpable mass. CT scan showed a right thyroid hemorrhagic cyst. The worker reported that he had jumped into the car trunk to extinguish the fire and covered the gas tank nozzle with his own body to prevent dispersal of the accelerant. In this case, the medico-legal evaluation was useful to delineate between natural and traumatic causes of the injury. Medico-legal assessment is key in understanding the dynamics involved in work-related events to identify any legal responsibilities of the worker or the employer. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively assess the prevalence of secondary overtriage (SO) within a rural regional Appalachian health care system. Methods: Trauma registry data was extracted for all trauma activation transfer patients from 2017 to 2022. Transferred patients were then stratified into two groups, non-secondary overtriage (non-SO) or SO. Patients were considered SO if they met three criteria following transfer: an Injury Severity Score (ISS) of less than 15, no required operative intervention, and discharge within 48 hours of arrival. Descriptive statistics were compared for age, length of stay (LOS), ICU LOS, and ISS. Surgical subspecialty consultations were compared between the two groups. Patients in the SO group were further assessed by body region of injury and Abbreviated Injury Score (AIS). Results: Among 3,291 trauma activation transfer patients, 43% (1,407) were considered SO transfers. Patients in the SO group were significantly younger, had shorter average hospital and ICU LOS, and lower ISS compared to the non-SO group. Additionally, 25.7% of patients in the SO group had injuries to the head or neck of which 8.96% have an AIS ≥3. 21% of patients had injuries to the face, with 0.14% having an AIS ≥3. Conclusions: 43% of transfer patients in this study met our definition of SO. Although no optimal rate of SO has been universally established, limiting SO stands to benefit both patients and trauma systems. This study highlights how institutional analysis of transfer patients may help inform transfer protocols to reduce secondary overtriage and overutilization of scarce resources. [ABSTRACT FROM AUTHOR]

Automatic Emergency Braking (AEB) has a direct impact on the effectiveness of the restraint systems in providing protection toward child occupants. The objective is to evaluate the effectiveness of Q6 and PIPER 6-year-old models in predicting the kinematic responses of child models, and further to quantify and analyze the child injuries during a frontal crash with and without AEB. The finite element model of a booster seat has been validated through a full vehicle test. Based on the validated finite element model, two sled test finite element models for the rear seat booster seat with Q6 and PIPER 6-year-old models were constructed. AEB condition was imposed on above the two models and the kinematic responses of sitting posture including head, neck and chest have been compared in detail. The peak head displacement and neck curvature of Q6 dummy and PIPER 6-year-old models have been compared with the test data from child volunteers. Based on the child model with better predictive capability for kinematic response under AEB, child injuries were evaluated and analyzed for the 50 km/h frontal crash test with and without AEB. Last, this study discussed the effects of internal neck and chest structure difference between Q6 and PIPER 6-year-old models on child kinematic response and the injury risks. Under AEB condition, PIPER 6-year-old model has higher head displacement and lower trunk displacement than Q6 dummy model, and the peak head displacement and neck curvature of PIPER 6-year-old model are similar to the test data of child volunteers. During the 50 km/h frontal crash simulation with pre-crash AEB, the HIC15, Head acceleration 3 ms, Nij decrease 43.7%, 19.6% and 28.8%, respectively and the chest deflection increases 15.5% compared to the simulation without AEB. This study shows that PIPER 6-year-old model is more suitable for the quantification of sitting posture change under AEB due to its higher biofidelity. The pre-crash AEB can substantially reduce the head, neck injuries. But it also increases the chest injury due to the chest pre-compression. Future efforts are recommended to lower the child chest injury by integrating AEB with active pre-tensioning seatbelts. [ABSTRACT FROM AUTHOR]

Background: Penetrating neck injuries are relatively rare but pose significant challenges due to the concentration of vital structures in this area. This case report presents a unique in-stance of a 20-year-old male with a penetrating neck injury caused by iron splinters, resulting in the rupture of the internal jugular vein and tension pneumothorax. Case Presentation: The patient, a 20-year-old male, presented with restlessness, chest pain, rapid breathing, and a penetrating wound on the left side of the neck. Initial management included needle decompression for tension pneumothorax and radiological assessments to localize the foreign body. C-arm revealed that the foreign body had penetrated the upper left thoracic region and lung parenchyma. The surgical intervention involved repairing the internal jugular vein and performing pulmonary resection to remove the iron splinters. Conclusions: This case highlights the importance of a multidisciplinary approach in managing complex penetrating neck injuries. Advanced imaging techniques and timely surgical interventions are crucial for optimizing patient outcomes. Future research should focus on refining diagnostic protocols and exploring minimally invasive surgical techniques to improve the management of such injuries.

Abstract Background data Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED. Methods We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into “c-spine injured” and “c-spine uninjured”. Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers. Results We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p

The human neck is a unique mechanical structure, highly flexible but fatigue prone. The rising prevalence of neck pain and chronic injuries has been attributed to increasing exposure to fatigue loading in activities such as prolonged sedentary work and overuse of electronic devices. However, a causal relationship between fatigue and musculoskeletal mechanical changes remains elusive. This work aimed to establish this relationship through a unique experiment design, inspired by a cantilever beam mechanical model of the neck, and an orchestrated deployment of advanced motion-force measurement technologies including dynamic stereo-radiographic imaging. As a group of 24 subjects performed sustained-till-exhaustion neck exertions in varied positions--neutral, extended, and flexed, their cervical spine musculoskeletal responses were measured. Data verified the occurrence of fatigue and revealed fatigue-induced neck deflection which increased cervical lordosis or kyphosis by 4-5° to 11°, depending on the neck position. This finding and its interpretations render a renewed understanding of muscle fatigue from a more unified motor control perspective as well as profound implications on neck pain and injury prevention. [ABSTRACT FROM AUTHOR]

The increased weight of multifunction and intelligent helmet systems can cause an exacerbation of the neck workload. Further, increased weight of the helmet can reduce the wearing comfort, and prolonged use may cause neck fatigue and even neck injury. This study evaluates the fatigue of neck muscles caused by wearing a helmet in motion using electromyography (EMG) measurement. Additionally, a comprehensive evaluation model for neck fatigue was established effectively. Twenty healthy subjects were selected to run for 10min continuously in each task by wearing two different helmets, respectively, during which the EMG signals of different neck muscles and subjective scores were recorded and analyzed. Two-way repeated measures analysis of variance (ANOVA) and Pearson correlation analysis were used to obtain indicators of neck fatigue, based on which the support vector machine (SVM) was used to construct a classification model of neck fatigue. By using integral EMG (IEMG) and root mean square (RMS) for assessing the neck injury in sternocleidomastoideus and trapezius muscles, it was observed that the mean power frequency (MPF) and median frequency (MF) in trapezius and splenius capitis could be used as effective evaluation indicators of neck fatigue. The EMG activity in trapezius was the highly sensitivity to fatigue when wearing helmets in motion. The classifier for distinguishing three different neck fatigue levels was 91.67% accurate. This study demonstrates the feasibility of an EMG-based method to evaluate the neck fatigue caused by wearing a helmet in motion, and also provides an evaluation method for the optimal design of helmets in the future. [ABSTRACT FROM AUTHOR]

Recurrent laryngeal nerve (RLN) injury during neck surgery can cause significant morbidity related to vocal cord (VC) dysfunction. VC electromyography (EMG) is used to aid in the identification of the RLN and can reduce the probability of inadvertent surgical injury. Errors in the placement of specialized EMG endotracheal tubes (ETT) can result in unreliable signals, false-negative responses, or no response when stimulating the RLN. We describe a novel educational protocol developed to optimize uniformity in the placement of ETTs to improve the reliability of RLN monitoring. An intraoperative neuromonitoring database was queried for all neck surgeries requiring RLN monitoring. Data points extracted for all cases requiring EMG monitoring for neck procedures. Free running and stimulated EMG were monitored and continuously recorded by a certified technologist. Alerts were compared between 2013–14 and 2015–18 using a two-sample test of proportions. Significant reductions in alerts were demonstrated after protocol implementation (7.5% pre-implementation to 2.1% post). Alerts were compared between 2013–14 (overall alert rate of 1.8%, pre-implementation period) and 2015–18 (overall alert rate of 2.8%, post-implementation period). Protocolization for placement of EMG-ETT improved accuracy in EMG monitoring. In the follow-up cohort of 1,080 patients, use of this protocol continued to reduce the rate of alerts related to ETT malposition, confirming the sustainability of this intervention through routine education. The risk of nerve injury is reduced when the rate of alerts is minimized. Scheduled or continuous protocol education of anesthesia personnel should continue to ensure compliance with protocol. [ABSTRACT FROM AUTHOR]

Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 −10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 – 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 – 4.5 vs control group - Md = 1.5, IQR 0.6 – 3.8, z = −0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn. • Topical silicone gel was comparable to emollient for facial wound healing. • Silicone gel was associated with improved early scar pigmentation outcomes. • No adverse effects were reported with the use of topical silicone gel. [ABSTRACT FROM AUTHOR]

Background: Dorema aucheri gum (DAG) is a bitter flavonoid gum widely used for numerous medicinal purposes including wound recovery. The present work investigates the acute toxicity and wound‐healing effects of DAG in excisional skin injury in rats. Materials and methods: Sprague Dawley rats (24) were clustered into four groups, each rat had a full‐thickness excisional dorsal neck injury (2.00 cm) and addressed with 0.2 mL of the following treatments for 15 days: Group A (vehicle), rats addressed with normal saline; Group B, rats received intrasite gel; C and D, rats addressed with 250 and 500 mg/kg of DAG, respectively. Results: The results revealed the absence of any toxic signs in rats who received oral dosages of 2 and 5 g/kg of DAG. Wound healing was significantly accelerated following DAG treatments indicated by smaller open areas and higher wound contraction percentages compared to vehicle rats. Histological evaluation revealed higher fibroblast formation, collagen deposition, and noticeably lower inflammatory cell infiltration in granulated skin tissues of DAG‐addressed rats compared to vehicle rats. DAG treatment caused significant modulation of immunohistochemical proteins (decreased Bax and increased HSP 70) and inflammatory mediators (reduced TNF‐α, IL‐6, and magnified IL‐10), which were significantly varied compared to vehicle rats. Moreover, topical DAG treatment led to significant upregulation of the hydroxyproline (HDX) (collagen) and antioxidant content. At the same time, decreased the lipid peroxidation (MDA) levels in healed tissues obtained from DAG‐treated rats. Conclusion: The present wound contraction by DAG might be linked with the modulatory effect of its phytochemicals (polysaccharides, flavonoids, and phenolic) on the cellular mechanisms, which justify their folkloric use and provokes further investigation as therapeutic drug additives for wound contraction. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric head and neck (HN) trauma is an important contributor to pediatric morbidity, resulting in significant downstream consequences. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population. Methods: A retrospective cohort study was conducted for patients (age <18 years) using the US National Trauma Data Bank (NTDB 2007–2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) >0. Logistic regression identified independent predictors of mortality following HN trauma. Results: Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0–4, the most common mechanism was falls (47.67% in this age group) while in ages 14–17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06%). Controlling for demographics, comorbidities, and injury severity, HN injury was associated with increased odds of mortality (OR 2.404, 95% CI 1.530–3.778). HN injury mortality was strongly predicted by firearm exposure (OR 11.28, 95% CI 6.074–20.95), age <4 (OR 1.179, 95% CI 1.071–1.299), and self‐insured status (OR 1.977, 95% CI 1.811–2.157). Conclusion: NTDB data demonstrate that the percentage of pediatric patients with HN trauma has decreased over the past 12 years although is associated with increased odds of mortality. Age and insurance status predicted mortality from HN trauma, with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: French Guiana (FG) is a French territory located in South America with the highest rate of armed assaults. FG presents a poorly developed road system and a young and precarious population that makes the geographical and socio-demographic characteristics specific. No data concerning the firearm injury management are available in this country. Studying thesis trauma could permit to improve the management of victims. The objective of this study is to investigate the epidemiology of firearm injuries in FG, to define characteristics of the victims, and to assess factors associated with death. These identified factors could enable target primary prevention and intensification of medical management. Methods: From January 2016 to December 2019, we conducted a retrospective study at the Cayenne General Hospital (CGH), including all patients admitted for firearm injuries in the emergency department, the medical emergency and resuscitation service, and the forensic service. A bivariate analysis was performed to assess relevant clinical data that were entered into a logistic regression model to assess factors associated with death. Results: A total of 871 files were analyzed concerning 340 patients included after cross-checking. Victims were mainly males (90%) and young (30 ± 11 years old). The injury occurred mainly at night (60%), in a context of assaults (83%) and with long-barreled guns (82%). Among the 290 patients managed at the CGH, 60% were hospitalized including 12% that were in the intensive care unit, 41% that required surgical treatment, and 7% that died in hospital. The overall average length of stay was 10 ± 18 days. Overall mortality (n = 71, 21%) is statistically associated with male gender (p = 0.007) and suicide context (p < 0.001). In multivariate analysis, the sites of wounds (head and neck, thorax; p < 0.001) as well as induced organ injuries (neurological, respiratory, and vascular; p < 0.005) were independent factors associated to mortality. Conclusions: This work underlines the high incidence of ballistic trauma in FG. This mainly involves a young and male population linked to the use of long arms and assaults. Despite the geographical difficulties of the territory and the technical platform deficits (no neurosurgery, no cardiothoracic surgery, no interventional radiology), the mortality is comparable to other studies, but remains more than twice as high as in mainland France. Finally, despite a change in legislation restricting access to firearms, our results show that gunshot firearm injuries remain a major public health concern requiring greater political actions. [ABSTRACT FROM AUTHOR]

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The term "mechanical neck pain" is a generic term used to define neck pain in people with neck injuries, neck dysfunction, or shoulder and neck pain. Several factors must be considered during the physical-therapy evaluation of cervical disorders, including changes in the visual systems and postural and proprioceptive balance. Currently, the Cervicocephalic Relocation Test (CRT) is used by physiotherapists to detect changes in cervical proprioception. This procedure requires precise equipment, customized installation in a dedicated area and, above all, a significant amount of time post-treatment for the doctor to make the diagnosis. An innovative system composed of Google's MediaPipe library combined with a personal laptop and camera is proposed and evaluated. The system architecture was developed, and a user interface was designed with the goal of allowing the system to be used more easily, more quickly, and more effectively by the healthcare practitioner. The tool is presented in this paper and tested in a use case, and the results are presented. The final user report, containing the visualization of the results of the CRT, which are ready for analysis by the physical therapist, can be exported from the developed tool. [ABSTRACT FROM AUTHOR]

Accurate assessment of cervical spine X-ray images through diagnostic metrics plays a crucial role in determining appropriate treatment strategies for cervical injuries and evaluating surgical outcomes. Such assessment can be facilitated through the use of automatic methods such as machine learning and computer vision algorithms. A total of 852 cervical X-rays obtained from Gachon Medical Center were used for multiclass segmentation of the craniofacial bones (hard palate, basion, opisthion) and cervical spine (C1–C7), incorporating architectures such as EfficientNetB4, DenseNet201, and InceptionResNetV2. Diagnostic metrics automatically measured using computer vision algorithms were compared with manually measured metrics through Pearson's correlation coefficient and paired t-tests. The three models demonstrated high average dice coefficient values for the cervical spine (C1, 0.93; C2, 0.96; C3, 0.96; C4, 0.96; C5, 0.96; C6, 0.96; C7, 0.95) and lower values for the craniofacial bones (hard palate, 0.69; basion, 0.81; opisthion, 0.71). Comparison of manually measured metrics and automatically measured metrics showed high Pearson's correlation coefficients in McGregor's line (r = 0.89), space available cord (r = 0.94), cervical sagittal vertical axis (r = 0.99), cervical lordosis (r = 0.88), lower correlations in basion-dens interval (r = 0.65), basion-axial interval (r = 0.72), and Powers ratio (r = 0.62). No metric showed adjusted significant differences at P < 0.05 between manual and automatic metric measuring methods. These findings demonstrate the potential of multiclass segmentation in automating the measurement of diagnostic metrics for cervical spine injuries and showcase the clinical potential for diagnosing cervical spine injuries and evaluating cervical surgical outcomes. [ABSTRACT FROM AUTHOR]

Penetrating posterior urethral trauma from gunshot wounds (GSW) is rare and requires prompt treatment to minimize complications. Data regarding the management of such cases is scarce in the literature and poorly addressed in the guidelines. Different management approaches exist, including urinary diversion with immediate versus delayed urethroplasty/fistula repair. We present our case series to add to our experience to the literature. Three patients aged 18–44 presented with ballistic posterior urethra injuries from GSW. Initial management involved urethral catheter placement, with one patient requiring operative placement of urethral and suprapubic catheters (SPTs). Complications included recurrent membranous stricture, urinary retention, rectourethral fistula, and erectile dysfunction (ED). Posterior urethral injuries from GSW are complex as they can be either isolated or affect adjacent organs. Bladder, ureteral, and urethral injuries must be ruled out. Unlike bladder neck injuries, immediate urethroplasty/fistula repair would be very challenging and not advised for standard prostatic or membranous injuries. Urethral catheter or suprapubic tube is recommended and can result in fistula closure and urethral patency. It is critical to maintain close follow‐up with the patient due to the possibility of stricture recurrence. Urethroplasty in a delayed fashion can be very successful. [ABSTRACT FROM AUTHOR]

Background data: Computed Tomography (CT) is the gold standard for cervical spine (c-spine) evaluation. Magnetic resonance imaging (MRI) emerges due to its increasing availability and the lack of radiation exposure. However, MRI is costly and time-consuming, questioning its role in the emergency department (ED). This study investigates the added the value of an additional MRI for patients presenting with a c-spine injury in the ED. Methods: We conducted a retrospective monocenter cohort study that included all patients with neck trauma presenting in the ED, who received imaging based on the NEXUS criteria. Spine surgeons performed a full-case review to classify each case into "c-spine injured" and "c-spine uninjured". Injuries were classified according to the AO Spine classification. We assessed patients with a c-spine injury detected by CT, who received a subsequent MRI. In this subset, injuries were classified separately in both imaging modalities. We monitored the treatment changes after the additional MRI to evaluate characteristics of this cohort and the impact of the AO Spine Neurology/Modifier modifiers. Results: We identified 4496 subjects, 2321 were eligible for inclusion and 186 were diagnosed with c-spine injuries in the retrospective case review. Fifty-six patients with a c-spine injury initially identified through CT received an additional MRI. The additional MRI significantly extended (geometric mean ratio 1.32, p < 0.001) the duration of the patients' stay in the ED. Of this cohort, 25% had a change in treatment strategy and among the patients with neurological symptoms (AON ≥ 1), 45.8% experienced a change in treatment. Patients that were N-positive, had a 12.4 (95% CI 2.7–90.7, p < 0.01) times higher odds of a treatment change after an additional MRI than neurologically intact patients. Conclusion and relevance: Our study suggests that patients with a c-spine injury and neurological symptoms benefit from an additional MRI. In neurologically intact patients, an additional MRI retains value only when carefully evaluated on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Introduction: Neck swellings are commonly found and can be presented as simple benign to malignant. Due to extensive differential diagnosis and similar presentation, the evaluation of neck swellings is more challenging. Most of the cases can be diagnosed after a detailed history and clinical examination of the head and neck, but the final diagnosis will be achieved by histopathological examination. Materials and Methods: The study was conducted from February 2020 to February 2023 on the basis of retrospective and prospective sampling. This study included all the patients with neck swellings, excluding thyroid, who had undergone excisional or incisional biopsy. The present study was carried out on 74 patients with non-thyroid neck swellings, which were classified five into main headings, i.e. lymph node swelling, salivary gland swellings, adipose tissue, neural tissue and skin and soft-tissue swellings as miscellaneous. Data were collected from patient records for retrospective sampling and radiological investigation, and ultrasonography (USG) and excisional or incisional biopsy were done for prospective sampling. A radiological and pathological correlation was analysed as benign and malignant. Results: Out of the 74 patients, n = 60, 81% were benign and n = 14, 19% were malignant. The most common swelling according to the tissue of origin was lymph node (n = 31, 41.9%) followed by salivary gland n = 15 (20.3%), adipose tissue (n = 7, 9.5%) and neural tissue (n = 6, 8.1%) origin. Other soft-tissue swellings were 20.3%. The overall sensitivity, specificity, positive predictive value, negative predictive value and radiological (USG) diagnosis accuracy to differentiate between benign and malignant are very similar to gold standard histopathological examination. Conclusion: Lymph node swellings were the most common swelling involving the neck region. USG diagnosis is highly sensitive for diagnosing malignant swellings but less good at confirming benign swellings. Radiological diagnosis is not a substitute for conventional surgical histopathology but is regarded as a precious complement in diagnosis. Newer diagnostic techniques are required to be infallible and accurate for further management. [ABSTRACT FROM AUTHOR]

Initial experiences with magnetic resonance imaging (MRI) of living strangulation victims demonstrated additional findings of internal injuries compared to the standard clinical forensic examination. However, existing studies on the use of MRI for this purpose mostly focused on the first 48 h after the incident. The aims of this study were (a) to evaluate the longitudinal visibility of MRI findings after violence against the neck by performing two MRI examinations within 12 days and a minimum of four days between both MRI scans and (b) to assess which MRI sequences were most helpful for the detection of injuries. Twenty strangulation victims participated in this study and underwent one (n = 8) or two (n = 12) MRI scans. The first MRI examination was conducted during the first five days, the second five to 12 days after the incident. Two blinded radiologists assessed the MRI data and looked for lesions in the structures of the neck. In total, 140 findings were reported in the 32 MRI examinations. Most of the findings were detected in the thyroid and the muscles of the neck. T2-weighted SPACE with fat suppression, T1-weighted TSE and T1-weighted MPRAGE were rated as the most helpful MRI sequences. Subjects who showed findings in the initial scan also demonstrated comparable results in the second scan, which was performed on average 8.4 days after the incident. Our results show that even up to 12 days after the incident, the criminal proceeding of strangulation cases may greatly profit from the information provided by an MRI examination of the neck in addition to the standard clinical forensic examination. [ABSTRACT FROM AUTHOR]

Children involved in car crashes can experience either direct trauma or inertial injuries resulting from interactions with external objects, such as other vehicles, or with the restraint system. Furthermore, improper use of restraint systems can lead to additional severe injuries. Recent reports from international institutions underscored the persistent prevalence of inadequate restraint systems utilization and this widespread issue increases children's vulnerability and risk of injuries. The aim of this study is to provide a systematic review of the literature on injuries sustained in children involved in road accidents describing and analyzing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving pediatric passengers. A total of 69 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the accident was examined and discussed. The review highlights that in motor vehicle accidents involving children, the forensic evaluation of both the cause of death and accident dynamics needs to consider several factors, such as the child's age, the type of restraint system employed, and the specific passenger seat occupied. Considering the complexity of the factors that can be involved in this road accident, it is crucial that there is a comprehensive exchange of information between the judge and the medical expert. [ABSTRACT FROM AUTHOR]

Background: Head-down tackling has been associated with higher rates of head and neck injuries and less successful tackles compared with head-up tackling in American football. In rugby, head and neck injuries have been associated with tackling, with the tackler's head positioned in front of the ball carrier. Purpose: To assess the success and risks of tackling techniques used in the English Rugby Premiership matches. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three reviewers analyzed 1000 consecutive solo defensive tackling attempts during the 2022 to 2023 season in 6 English Rugby Premiership matches. Slow-motion replays were used to analyze the success of the tackling attempt in terms of head angulation (head up vs head down), head position relative to the offensive player's waist at point of contact, and tackling method (inside shoulder, arm, head across the bow, and head-to-head). The chi-square test or Fisher exact test was used to analyze categorical data, and the 2-tailed Student t test or the Mann-Whitney U test was used to analyze continuous data. Results: The mean interrater reliabilities for analyzing the tackles were good across all groups (κ = 0.715). Head-up and head-down tackling occurred in 848 tackle attempts (84.8%) and 152 tackle attempts (15.2%), respectively. Head-up tackles were successful in 80.7% of the tackle attempts compared with 71.1% of the head-down tackle attempts (P =.0072). Tackles made at or above the waist were successful in 80.7% of the tackle attempts compared with 73.1% of tackles below the waist (P =.0193). The inside-shoulder technique had the highest successful tackle rate at 90.8%, compared with 44.2% with the arm technique (P <.0001) and 72.4% with the head-across-the-bow technique (P <.0001). The inside-shoulder technique resulted in head-up tackling in 84.8% of players compared with 59.8% with the head-across-the-bow technique (P <.0001) and 94.9% with arm tackling (P =.0001). There were 4 recorded injuries to the tackler: 2 neck injuries, 1 shoulder injury, and 1 wrist/hand injury. Conclusion: Head-up tackling, tackles made at or above the level of the offensive player's waist, and inside-shoulder tackling were found to be more efficient in producing successful tackles. The head-down, tackling below the waist, and head-across-the-bow techniques were associated with poor tackling and lower success rates. [ABSTRACT FROM AUTHOR]

Background: Transient traumatic neuropraxia of either the brachial plexus or cervical nerve root(s) is commonly described as a "stinger" or "burner" by the athlete. Stingers in American Football commonly occur acutely as isolated injuries; however, concomitant injuries, including cervical spine pathologies, have also been reported. Hypothesis: Among National Football League (NFL) athletes, the incidence rate of stingers is higher during the regular season than during the preseason and among positions with high velocity impacts such as running backs, linebackers, defensive backs, and receivers. Study Design: Retrospective epidemiology study. Level of Evidence: Level 4. Methods: Aggregation of all in-game injuries with a clinical impression of "neck brachial plexus stretch" or "neck brachial plexus compression" entered into the NFL injury surveillance database through the centralized league-wide electronic medical record system over 5 years (2015-2019 seasons). Incidence rates per player-play were calculated and reported. Results: A total of 691 in-game stingers occurred during the study period, with a mean of 138.2 per year. Average single-season injury risk for incident stinger was 3.74% (95% CI, 3.46%-4.05%). The incidence rate was higher during regular season games than during preseason games (12.26 per 100,000 player-plays [11.30-13.31] vs 8.87 [7.31-10.76], P < 0.01, respectively). The highest reported stinger incidence rates were among running backs and linebackers (both >15 per 100,000 player-plays). Among stingers, 76.41% did not miss time. Of those that resulted in time lost from football activities, mean time missed due to injury was 4.79 days (range, 3.17-6.41 days). Concomitant injuries were relatively low (7.09%). Conclusion: In-game stinger incidence was stable across the study period and occurred most frequently in running backs and linebackers. Stingers were more common during the regular season, and most players did not miss time. Concomitant injuries were relatively rare. Clinical Relevance: An improved understanding of the expected time loss due to stinger and concomitant injuries may provide insight for medical personnel in managing these injuries. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease which damages upper and lower motor neurons (UMN and LMN) innervating the muscles of the trunk, extremities, head, neck and face in cerebrum, brain stem and spinal cord, which results in the progressive weakness, atrophy and fasciculation of muscle innervated by the related UMN and LMN, accompanying with the pathological signs leaded by the cortical spinal lateral tract lesion. The pathogenesis about ALS is not fully understood, and no specific drugs are available to cure and prevent the progression of this disease at present. In this review, we reviewed the structure and associated functions of copper-zinc superoxide dismutase 1 (SOD1), discuss why SOD1 is crucial to the pathogenesis of ALS, and outline the pathogenic mechanisms of SOD1 in ALS that have been identified at recent years, including glutamate-related excitotoxicity, mitochondrial dysfunction, endoplasmic reticulum stress, oxidative stress, axonal transport disruption, prion-like propagation, and the non-cytologic toxicity of glial cells. This review will help us to deeply understand the current progression in this field of SOD1 pathogenic mechanisms in ALS. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To explore self‐reported dentofacial trauma and their potential endodontic sequelae in boxers using a questionnaire, followed by clinical and radiographic assessment to (1) compare the nature and number of self‐reported dentofacial injuries with physical evidence of injury sequelae; and (2) investigate potential risk factors influencing dentofacial trauma and their endodontic sequelae.A focus group validated questionnaire was completed by 176 boxers recruited from 16 London boxing clubs; 61 boxers from this cohort then attended a London dental hospital, for a clinical and radiographic assessment. Data from the questionnaire and clinical assessments were then collated and analysed using Chi‐squared or t‐tests.Questionnaire data revealed 87.5% of boxers reported a history of dentofacial trauma during boxing activity. The clinical and radiographic assessment detected evidence of dentofacial trauma in 91.8% of boxers and dental injury or endodontic‐related injury sequelae in 68.9% of boxers. There was a significant association between dentofacial trauma and boxers who did not participate in weekly neck weight sessions (p < .001), and there was a significant association between trauma‐related endodontic sequelae and: boxer age (p = .01); competitions per month (p = .002); and defensive skill (p = .007).A majority of the cohort had suffered dentofacial injuries and endodontic sequelae. The questionnaire data under‐reported musculoskeletal injuries and endodontic sequelae, suggesting that some hard‐tissue injuries following repetitive dentofacial trauma may have a subclinical presentation. Injury risk may be related to increased boxer age, defensive skills, frequency of participation in competitions, and frequency of neck weight sessions per week. [ABSTRACT FROM AUTHOR]

Lameness and leg injuries are both painful and prevalent across the dairy industry, and are a major welfare concern. There has been a considerable amount of research focused on investigating the risk factors associated with lameness and injuries and how they might be prevented and treated. The objectives of this narrative review were to summarize herd-level prevalence estimates, risk factors, strategies for prevention, control, and treatment of these conditions, and the barriers to best practice adoption for lameness and injuries on dairy farms. There is a relatively high within-herd prevalence of lameness on dairy farms globally, with a recent systematic review estimating the mean prevalence at 22.8%. Similarly, there is a relatively high prevalence of hock injuries, with within-herd estimates ranging from 12% to 81% of cows affected. Knee and neck injuries have been reported to be less common, with 6% to 43% and 1% to 33%, respectively. Numerous risk factors have been associated with the incidence of lameness, notably housing (e.g., access to pasture, bedding depth, bedding type, flooring type, stall design), management (e.g., stall cleanliness, frequency of trimming, holding times, stocking density), and cow-level (e.g., body condition, parity, injured hocks) factors. Risk factors associated with hock injuries can be similarly classified into housing (e.g., bedding type and depth, outdoor access, parlor type, stall design), management (e.g., bedding depth, cleanliness), and cow (e.g., parity, days in milk, lameness) factors. Key preventative approaches for lameness include routine preventative and corrective hoof trimming, improving hoof cushioning and traction through access to pasture or adding rubber flooring, deep-bedded stalls, sand bedding, ensuring appropriate stocking densities, reduced holding times, and the frequent use of routine footbaths. Very little research has been conducted on hock, knee, and neck injury prevention and recovery. Numerous researchers have concluded that both extrinsic (e.g., time, money, space) and intrinsic (e.g., farmer attitude, perception, priorities, and mindset) barriers exist to addressing lameness and injuries on dairy farms. There are many diverse stakeholders in lameness and injury management including the farmer, farm staff, veterinarian, hoof trimmer, nutritionist, and other advisors. Addressing dairy cattle lameness and injuries must, therefore, consider the people involved, as it is these people who are influencing and implementing on-farm decisions related to lameness prevention, treatment, and control. [ABSTRACT FROM AUTHOR]

This study examined injuries sustained by a six-year-old child dummy in a numerical dolly rollover crash using a Toyota Yaris 2010. A harmonic dynamic system (HDS) composed of spring, dampers, and masses with a Low Back Booster (LBB) is denominated as HDS-LBB model. The HDS-LBB was designed to allow damping movements along three Cartesian axes (X, Y, Z) to reduce the energy transferred to the child by a motor vehicle accident and avoid a high injury risk. The HDS-LBB incorporates springs into the vertical axis to decrease the vertical movement during the rollover. The numerical analysis was conducted using LS-Dyna® R12.1 version during an interval of 1 s, and the boundary conditions were set by the Federal Motor Vehicle Safety Standard (FMVSS) 213 for child restraint recommendations and the FMVSS 208 for a dolly rollover procedure. Data on head and thorax decelerations, neck flexion-extension, and thoracic deflection were acquired at a rate of 1 ms. The injury values obtained by the HDS-LBB were compared with the injury values by another configuration denominated LBB-ISOFIX to assess the effectiveness of the model proposed. The results show a higher peak injury value in the neck and thorax because of seatbelt displacement across the child's shoulder. Nevertheless, despite this seatbelt behavior, the injuries sustained remained below the Injury Assessment Reference Values (IARVS). [ABSTRACT FROM AUTHOR]

Purpose: Although functional and esthetic results after the use of a scapular tip free flap (STFF) in head and neck reconstruction, and the related donor-site morbidity, have been extensively described, data regarding acute postoperative donor-site pain management are lacking. Purpose of this study is to explore the use of mini-catheters to administer local anesthetics for donor-site pain management after reconstruction using STFF. Methods: Patients who underwent head and neck reconstruction using a STFF were prospectively enrolled and, through a perineural catheter placed in the donor site during the surgical procedure, a bolus of chirochaine was injected before the patient regained consciousness and at 8, 16, and 24 h postoperatively. Before and 40 min after each dose administration, donor-site pain on a numerical rating scale (NRS; 0–10) was evaluated. Results: Study population consisted of 20 patients (40–88 years). At 8 h, the pain scores before and after the injection were 0–10 (mean 3.35) and 0–5 (mean 1.25), respectively. At 16 h, the pain scores before and after the injection were 0–8 (mean 2.55) and 0–4 (mean 0.55), respectively. At 24 h, the pain scores before and after the injection were 0–8 (mean 1.30) and 0–4 (mean 0.30), respectively. Conclusion: Statistical analysis confirmed a significant difference between the pain scores before and after administration at 8, 16, and 24 h (p < 0.001, p < 0.001, and p = 0.003, respectively). Mini-catheters for local anesthetic administration represent an effective strategy for pain control after STFF harvesting for head and neck reconstruction. [ABSTRACT FROM AUTHOR]

Till date, a pharyngocutaneous fistula has been exclusively reported as a sequela of laryngo-pharyngectomy. We are reporting the first-of-its-kind case of pharyngocutaneous fistula following a penetrating neck injury. As conservative management failed, surgical repair was performed using a loco-regional muscular flap with complete success. [ABSTRACT FROM AUTHOR]

Background. Scapular fracture is a rare encounter in blunt trauma patients. The scapula is surrounded by strong groups of muscles offering good protection for the bone. Therefore, a high-energy trauma is needed to cause a scapular fracture. We aim to study scapular fractures and their relation to injury severity and mortality in blunt chest trauma (BCT) patients. Methods. We retrospectively collected data from all patients with BCT who were admitted to our hospital from December 2014 through January 2017. The injury details of all BCT patients were retrieved from the trauma registry of the hospital and were supplemented by patients' electronic files for missing information. Collected data included demography, mechanism of injury, vital signs, Glasgow Coma Score (GCS) on admission, injured body regions, management, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of hospital stay (LOS), and mortality. Results. During the study period, 669 patients had BCT. Scapular fracture was present in 29 (4.3%) of the BCT patients. The scapular fracture was missed by chest X-ray in 35.7% of the patients; however, it was accurately diagnosed by computed tomography (CT) scan of the chest. Neck injury was significantly higher in patients with scapular fracture compared with patients without fracture (p < 0.001). ISS and NISS were significantly higher in patients with scapular fractures compared to other patients without fractures (p = 0.04 and p = 0.003 Mann–Whitney U test, respectively). Two patients with scapular fractures died due to severe associated injuries (the overall mortality was 9.6%). Conclusions. Scapular fracture in BCT patients indicates a high-energy type of trauma. Compared to a chest X-ray, CT scan was more accurate for the diagnosis of scapular fracture. Associated injuries are the main cause of trauma-related mortality rather than the direct effect of the fractured scapula. Particular attention and meticulous evaluation should be paid to head and neck injuries to avoid missing injuries. [ABSTRACT FROM AUTHOR]

Background: Cut throat injuries are one of the most challenging surgical emergencies encountered by Ear, nose, throat (ENT) surgeons. If not treated in time, they may lead to death. Prevention of mortality depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of bleeding, and wound closure. Aims and Objectives: Our study was conducted to observe and analyze: 1. The sociodemographic profile of cut throat injury patients admitted in our hospital. 2. The modes of cut throat injury cases admitted in our hospital. 3. Anatomical region and depth of the cut throat injury patients admitted in our hospital. 4. Treatment of cut throat injury patients given at our hospital. Materials and Methods: This is a prospective study of about 25 cases of cut throat injury presented to the emergency department in our tertiary care hospital situated in the rural area of Tamilnadu (India), between June 2021 and September 2022. Cut throat injury patients were managed by multidisciplinary approach headed by the ENT team. Results: In our study, 72% were males and 28% were females. The peak age of incidence is fourth decade (48%). People with lower socioeconomic status were affected more (40%). Eighty percent of the patients had Zone II injuries. Seventy-six percent of cases presented with active bleeding and 60% of cases came with breathing difficulty. The most common cause of cut throat injury had been found to be suicidal (52%). Sixty percent had laryngeal injuries. Seventy-two percent of the cases were managed with tracheostomy. Conclusion: Our study found that the majority of cut throat injury patients were males of age between 30 years to 40 years from poor socioeconomic status. Social involvement and political motivation, poverty reduction, individual awareness, increase in economic growth along with literacy rate will prevent the cut throat injuries. Early and improved proper management will reduce the mortality and morbidity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although ambient temperature has been linked with injury incidence, there have been few nationwide studies to quantify the temperature-related risk and burden of cause-specific injury hospitalizations. Additionally, the impact of human-induced climate change to injury burden remains unknown. OBJECTIVES: Our objectives are to examine the associations between ambient temperature and injury hospitalizations from various causes and to quantify the contribution of human-induced warming to the heat-related burden. METHODS: We collected injury hospitalization data from a nationwide hospital-based registry in China during 2000–2019. Using a time-stratified case-crossover design, we investigated the associations between daily mean temperature (°C) and cause-specific injury hospitalizations. We also quantified the burden of heat-related injuries under the scenarios with and without anthropogenic forcing, using the Detection and Attribution Model Intercomparison Project to assess the contribution of human-induced warming. RESULTS: Our study included a total of 988,087 patients with hospitalization records for injuries. Overall, compared to the temperature at minimum risk of hospitalization (-12:1°C), the relative risk of hospitalization at extreme hot temperature (30.8°C, 97.5th percentile) was 1.18 [95% confidence interval (CI): 1.14, 1.22], with an approximately linear association between temperature and hospitalization. Vulnerability to heat-related injuries was more pronounced among males, young (<18 years of age) or middle-aged (45–64 years of age) individuals, and those living in the North. The heatrelated attributable fraction increased from 23.2% in the 2000s to 23.6% in the 2010s, with a corresponding increase in the contribution of humaninduced change over time. In the 2010s, the heat-related attributable fractions for specific causes of injury ranged from 12.4% to 54.4%, with humaninduced change accounting for 6.7% to 10.6% of the burden. DISCUSSION: This nationwide study presents new evidence of significant associations between temperature and cause-specific injury hospitalizations in China and highlights the increasing contribution of human-induced warming to the injury burden. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the incidence and patterns of maxillofacial fractures and the demographic characteristics of associated head and neck injuries. This single-center retrospective cohort study was conducted at the Department of Oral and Maxillofacial Surgery of King Abdullah University Hospital (KAUH) in Irbid, northern Jordan. The data was obtained from the electronic clinical records of all patients in whom maxillofacial fractures and associated head and neck injuries were confirmed. During the five-year period captured by this retrospective study, 481 patients with 1026 maxillofacial fractures (equivalent to 2.13 fractures per patient) were treated. The sample comprised of 369 (76.7%) males and 112 (23.3%) females, resulting in a male/female ratio of 3.3:1. Majority of the patients were in the 21–30 age group and RTA was the most common cause of maxillofacial fractures, accounting for 299 (62.1%) of the analyzed cases. In 316 cases, maxillary fractures were accompanied by associated injuries, 132 (41.77%) of which were intracranial lesions, 80 (25.32%) were skull fractures, and 59 (18.67%) were cervical spine injuries. Based on the obtained data, it can be concluded that the high occurrence of RTA emphasizes the significance of adhering to traffic laws and regulations, as individuals who have suffered serious head and neck injuries as a result of maxillofacial trauma may experience potentially fatal consequences. Thus, management for patients with maxillofacial fractures and concomitant traumas should be multidisciplinary and coordinated. [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review and Meta-Analysis. Objective: Identify the incidence, mechanism of injury, investigations, management, and outcomes of Vertebral Artery Injury (VAI) after cervical spine trauma. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines (PROSPERO-ID CRD42021295265). Three databases were searched (PubMed, SCOPUS, Google Scholar, CINAHL PLUS). Incidence of VAI, investigations to diagnose (Computed Tomography Angiography, Digital Subtraction Angiography, Magnetic Resonance Angiography), stroke incidence, and management paradigms (conservative, antiplatelets, anticoagulants, surgical, endovascular treatment) were delineated. Incidence was calculated using pooled proportions random effects meta-analysis. Results: A total of 44 studies were included (1777 patients). 20-studies (n = 503) included data on trauma type; 75.5% (n = 380) suffered blunt trauma and 24.5% (n = 123) penetrating. The overall incidence of VAI was.95% (95% CI 0.65-1.29). From the 16 studies which reported data on outcomes, 8.87% (95% CI 5.34- 12.99) of patients with VAI had a posterior stroke. Of the 33 studies with investigation data, 91.7% (2929/3629) underwent diagnostic CTA; 7.5% (242/3629) underwent MRA and 3.0% (98/3629) underwent DSA. Management data from 20 papers (n = 475) showed 17.9% (n = 85) undergoing conservative therapy, anticoagulation in 14.1% (n = 67), antiplatelets in 16.4% (n = 78), combined therapy in 25.5% (n = 121) and the rest (n = 124) managed using surgical and endovascular treatments. Conclusion: VAI in cervical spine trauma has an approximate posterior circulation stroke risk of 9%. Optimal management paradigms for the prevention and management of VAI are yet to be standardized and require further research. [ABSTRACT FROM AUTHOR]

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Coronavirus disease 2019 (COVID-19) has affected daily activities since December 2019. Burn injuries to head and neck can result in cosmetic and functional deformities. The purpose of this study was to characterize patients with burns to head and neck during the pandemic. This cross-sectional study reviewed patients in Burn Care Quality Platform Registry. Patients were included if they were aged 18 years or older and sustained burns to head and neck. Patients were stratified according to the date of injury into 1) March 13 to September 13, 2019 (ie, before COVID-19 pandemic, BC19) or 2) March 13 to September 13, 2020. March 13, 2020 was chosen because 1) COVID-19 was announced as a national emergency on that date and 2) it was the last day of in-person schools in the state of Georgia. Data collection included patient demographics, admission details, burn details, and hospital-related variables. During the study period, 157 patients had burns to head and neck (BC19, 70; C19, 71). Our data showed a 375% increase in March following the announcement of the pandemic (BC19, 4; C19,19). Admissions from another facility were statistically more than in the C19 group (P ≤.0001). For the C19 group, there were 53% more admissions from the emergency department than the BC19 group (P  = .001). Additionally, in the BC19 group, patients presented with concomitant inhalation injuries significantly more than the C19 group (P  = .04). In conclusion, the total number of burns is the same during BC19 and C19; however, there was a significant spike in the number of cases in March 2020. [ABSTRACT FROM AUTHOR]

Background: A large proportion of United States (U.S.) youth play basketball, baseball, softball, or T-ball. Each of the activities poses a documented risk of craniofacial and neck injuries. However, few studies have assessed the national prevalence of pediatric craniofacial and neck injuries in this population, particularly following the COVID-19 pandemic. Methods: The National Electronic Injury Surveillance System (NEISS) dataset was used to identify pediatric craniofacial and neck injuries associated with basketball, baseball, softball, or T-ball from 2003–2022 in a cross-sectional study. The annual number of injuries before and after the onset of the COVID-19 pandemic with 95% confidence intervals were calculated. Interrupted time series analysis (ITSA) was used to estimate the pandemic's impact on the monthly number of injuries incurred nationally. Results: Both overall and stratified by sport involvement, the annual number and rate of injuries identified in NEISS decreased significantly after the COVID-19 pandemic. ITSA demonstrated that the monthly number of injuries decreased -4094.4 (95% CI = -5100, -3088.7) immediately after the beginning of the pandemic. The number of injuries began increasing towards pre-pandemic levels at a rate of 110.6 (95% CI = 64, 157.2) injuries per month after the initial plunge. Conclusion: Prior to the-pandemic, there was a steady decline in craniofacial and neck injuries due to basketball, baseball, softball and T-ball among children, aged <18 years. The shutdown during the initial months of the COVID-19 pandemic resulted in a precipitous drop in such injuries. Current rates are approaching pre-pandemic levels and may exceed them. Continued efforts are needed to keep the pre-pandemic progress. [ABSTRACT FROM AUTHOR]

Penetrating head and neck injuries are rare but life-threatening injuries. These injuries are classified into 3 regions in the neck. Injuries involving all 3 regions are almost absent in the literature. Appropriate personal protective equipment must be used to protect from such injuries. In this case report, a case remarkable for a foreign body causing injury is presented. [ABSTRACT FROM AUTHOR]