OBJECTIVE: Head/orofacial (H/O) injuries are common in Australian rules football. Mouthguards are widely promoted to prevent these injuries, in spite of the lack of formal evidence for their effectiveness. DESIGN: The Australian football injury prevention project was a cluster randomized controlled trial to evaluate the effectiveness of mouthguards for preventing H/O injuries in these players. SETTING AND SUBJECTS: Twenty three teams (301 players) were recruited from the largest community football league in Australia. INTERVENTION: Teams were randomly allocated to either the MG: custom made mouthguard or C: control (usual mouthguard behaviours) study arm. MAIN OUTCOME MEASURES: All injuries, participation in training and games, and mouthguard use were monitored over the 2001 playing season. Injury rates were calculated as the number of injuries per 1000 person hours of playing time. Adjusted incidence rate ratios were obtained from Poisson regression models. RESULTS: Players in both study arms wore mouthguards, though it is unlikely that many controls wore custom made ones. Wearing rates were higher during games than training. The overall rate of H/O injury was 2.7 injuries per 1000 exposure hours. The rate of H/O injury was higher during games than training. The adjusted H/O injury incidence rate ratio was 0.56 (95% CI 0.32 to 0.97) for MG versus C during games and training, combined. CONCLUSIONS: There was a significant protective effect of custom made mouthguards, relative to usual mouthguard use, during games. However, the control players still wore mouthguards throughout the majority of games and this could have diluted the effect. (+info)
(34/169) Biomechanics of the head for Olympic boxer punches to the face.
OBJECTIVE: The biomechanics of the head for punches to the jaw and the risk of head injury from translational and rotational acceleration were studied. [figure: see text] METHODS: Seven Olympic boxers from five weight classes delivered 18 straight punches to the frangible face of the Hybrid III dummy. Translational and rotational head acceleration, neck responses, and jaw pressure distribution were measured. High speed video recorded each blow and was used to determine punch velocity. Equilibrium was used to determine punch force, energy transfer, and power. RESULTS: Punch force averaged 3427 (standard deviation (SD) 811) N, hand velocity 9.14 (SD 2.06) m/s, and effective punch mass 2.9 (SD 2.0) kg. Punch force was higher for the heavier weight classes, due primarily to a higher effective mass of the punch. Jaw load was 876 (SD 288) N. The peak translational acceleration was 58 (SD 13) g, rotational acceleration was 6343 (SD 1789) rad/s(2), and neck shear was 994 (SD 318) N. CONCLUSIONS: Olympic boxers deliver straight punches with high impact velocity and energy transfer. The severity of the punch increases with weight class. (+info)
(35/169) Hemodynamic effect of propofol in enalapril-treated hypertensive patients during induction of general anesthesia.
Angiotensin converting enzyme inhibitor (ACE-I) treated hypertensive patients are well known to be at risk during general anesthesia, because of hypotension that can occur. We compared hemodynamic changes in these patients during induction of general anesthesia with propofol and etomidate - two intravenous anesthetics. Hypotension after propofol that we observed in ACE-I group versus normotension after etomidate (p < 0.001) in our opinion may be the result of additive effect of similar endothelium-dependent mechanism of action of propofol and ACE-I, i.e. increase in production and release of nitric oxide (NO). This very unique observation, however, needs further investigation to precisely define the mechanism of our finding. (+info)
(36/169) An ultrastructural study on indirect trauma of dental pulp caused by maxillofacial impact injury in dogs.
BACKGROUND: Indirect injuries of adjacent tissues and organs usually accompany maxillofacial impact injuries. However, studies on indirect dental pulp injury are rare. This study was designed to determine the characteristics of indirect dental pulp injury caused by impact injury of mandible in dogs. METHODS: Eighteen dogs were divided equally into six groups with random allocation. Right mandible of each dog was impacted but teeth were not injured directly. Then, the animals were killed at appointed time points and ultrastructural changes in dental pulp of assigned teeth of each dog were investigated with transmission electron microscope. RESULTS: Dental pulp of the fourth premolar of right mandible was injured very severely, but irreversible necrosis did not occur in the end. Dental pulp of the second premolar of right mandible was injured less severely and reversibly. Dental pulp of the second premolar of left mandible was injured mildly and temporarily. CONCLUSION: In the indirect injury of dental pulp caused by maxillofacial impact injury, the injured area is relatively extensive. The effect of the trauma decreases progressively and sharply as the distance to the impact site increases. Ultrastructural changes in the damaged nerves take place early. (+info)
(37/169) Video analysis of falls experienced by paediatric iceskaters and roller/inline skaters.
OBJECTIVES: To evaluate differences in the way iceskaters and roller/inline skaters fall. METHODS: Children's falls related to skating were videotaped and categorised based on type of skating activity, child's estimated age, direction of fall, whether the child attempted to break the fall, and whether the head struck the skating surface. RESULTS: In total, 216 iceskating and 201 roller/inline skating falls were captured on videotape. In both iceskating and roller/inline skating, the majority of falls were forward in direction. The skaters attempted to break the falls with their arms or hands in over 90% of falls in both iceskating (93.1%) and roller/inline skating (94.5%). A greater proportion of falls in iceskating resulted in the head striking the skating surface (13.0%) than did those in roller/inline skating (3.0%) (odds ratio = 4.8; 95% confidence interval 1.9 to 13.3; p<0.001). CONCLUSIONS: This study found that paediatric iceskaters and roller/inline skaters fall similarly and that both types of skaters try to break their falls with their arms or hands; however, because iceskating takes place on a low friction surface, attempts to break falls with the arms or hands are often unsuccessful, leading to head and face injuries. The development of a new type of protective gear, a wrist guard with a non-slip palm, should stop iceskaters from striking the head, protect against upper extremity fractures, and unlike a bulky helmet, should not discourage children from skating. (+info)
(38/169) Current management of facial wounds in UK accident and emergency departments.
INTRODUCTION: The objective of this study was to determine the current practice in the management of adult facial soft tissue injuries in patients presenting to UK accident and emergency departments. MATERIALS AND METHODS: Questionnaire study to the lead clinicians of 217 UK emergency departments seeing over 30,000 new patients annually. RESULTS: There was a 76% response rate. Suturing was the preferred method of closure, with the majority of clinicians preferring 6/0 or 5/0 non-resorbable sutures. Use of a regional nerve block would be considered by a quarter of clinicians, and adrenaline vasoconstrictor by a third. Referral rates ranged from 5-77% for a more complex wound. Maxillofacial services were preferred by 51% of respondents; on-site referral availability was indicated by only 28%, with an average journey of 16 miles for treatment. Up to 30% of clinicians considered prescribing antibiotics after wound closure, with flucloxacillin and co-amoxiclav most commonly suggested. Accident and emergency review rates ranged from 16% to 45%, with most wounds either being referred to the GP or no formal review being suggested. CONCLUSIONS: The results of this survey suggest that there is considerable variation in the initial management, referral and review of facial wounds in the UK. Further work is required to formulate guidelines for optimal patient care, ideally in conjuncture with the receiving surgical specialties. (+info)
(39/169) Muscular subunits transplantation for facial reanimation.
PURPOSE: To present an alternative technique for reconstruction of musculocutaneous damages in the face transferring innervated subsegments (subunits) of the latissimus dorsi flap for replacement of various facial mimetic muscles. METHODS: One clinical case of trauma with skin and mimetic muscles damage is described as an example of the technique. The treatment was performed with microsurgical transfer of latissimus dorsi muscle subunits. Each subunit present shape and dimensions of the respective mimetic muscles replaced. The origin, insertions and force vectors for the mimic muscle lost were considered. Each subsegment has its own arterial and venous supply with a motor nerve component for the muscular unit. RESULTS: Pre and one year postoperative photos registration of static and dynamic mimic aspects, as well as digital electromyography digital data of the patients were compared. The transplanted muscular units presented myoelectric activity, fulfilling both the functional and cosmetic aspect. CONCLUSION: This technique seems to be a promising way to deal with the complex musculocutaneous losses of the face as well as facial palsy. (+info)
(40/169) Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore.
INTRODUCTION: To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. METHODS: Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. RESULTS: 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05), non-residents and bicyclists aged 30 years or older (p-value is 0.011) believed that helmets did not protect against head injury. Comparing the helmeted group with the non-helmeted group, injury patterns by body region were: head injury 5.9 percent versus 40.0 percent (p-value is less than 0.01); facial injury 5.9 percent versus 37.1 percent (p-value is less than 0.05). Not wearing a helmet, being hit by a motor vehicle and age were significantly associated with higher injury severity scores, after adjusting for several potential confounding factors. CONCLUSION: Bicycle helmet use was low in our sample of injured patients. When worn, protection against injury was demonstrated. A campaign to promote use of bicycle helmets should be targeted at non-residents and older bicyclists. Authorities should consider compulsory helmet laws for bicyclists and expanding anti-drunk driving campaigns to target alcohol-intoxicated bicyclists. (+info)