Non-fatal injuries sustained by seatbelt wearers: a comparative study.
The injuries sustained by 969 drivers and front-seat passengers in road-traffic accidents were studied. Altogether 196 (20-2%) of the drivers and passengers were wearing seat belts and 773 (79-8%) were not. The injuries among the two groups differed greatly in both severity and distribution. A total of 54 (27-6%) of the seatbelt wearers sustained one or more fractures compared with 300 (38-8%) of the non-wearers, and 18 (9-2%) of the seatbelt wearers were severely injured compared with 300 (38-8%) of the non-wearers. Soft-tissue injuries to the face were sustained by only 29 (14-8%) of the seatbelt wearers compared with 425 (55%) of the non-wearers. Since wearing seatbelts may become compulsory, the type and pattern of injuries to be expected in wearers should be appreciated. (+info)
Systemic hormonal, electrolyte, and substrate changes after non-thermal limb injury in children.
Relatively little is known regarding the hormonal changes after injury in children. Adult protocols are often applied to children, although the latter often have different physiological responses to trauma. Twenty children with an angulated displaced fracture of the radius and/or ulna (injury severity score 9) were studied prospectively for changes in adrenaline, noradrenaline, cortisol, angiotensin II, arginine vasopressin, urea, electrolytes, and glucose. Two blood samples were taken: one an arrival at the accident and emergency department and one preoperatively several hours later. There were marked increases in adrenaline, noradrenaline, cortisol, and arginine vasopressin above the normal range. Five (25%) cases demonstrated greater early increases in adrenaline than those reported for adult injuries of similar severity. Early hypokalaemia in four cases had corrected towards normal within a few hours, without potassium supplementation. (+info)
Injuries caused by falling soccer goalposts in Denmark.
OBJECTIVE: A falling soccer goalpost is associated with the potential risk of serious injury that can sometimes even be fatal. The aim of the study was to analyse the extent of the problem in Denmark and focus on the mechanism of injury and prevention. METHODS: Data were analysed for the period 1989-1997 from the European Home and Leisure Accident Surveillance System, which is an electronic register of the injuries seen in the casualty departments of the hospitals of five selected cities in Denmark representing 14% of the Danish population; in addition, fatal accidents in the whole of Denmark since 1981 were examined. Forty two injured persons were interviewed about the circumstances of the accident. Attempts were made to estimate the proportion of goalposts secured by counterweight in the five different regions, compared with the proportion secured with ground stakes and those that were unsecured, by analysing data from the largest producers of goalposts in Denmark. RESULTS: In the period 1981-1988, two fatal accidents were recorded. In the period 1989-1997, 117 people were injured by a falling goalpost; six of the injuries required hospitalisation. Some 88% of the injured were under the age of 15. In a telephone interview with 42 of the injured, 50% stated that the goalpost fell because someone was hanging on the crossbar. Comparing the five different regions with respect to the proportion of goalposts secured by counterweight and the number of accidents, the following relation was found. Areas in which a high percentage of the goalposts were secured by a counterweight correlated inversely with a high number of accidents (r = -0.9; p = 0.04). CONCLUSION: Soccer is a widely played sport and it is important to be aware that accidents caused by falling goalposts can occur and that they presumably can be prevented by proper use of goalposts, by using secure goalposts, and by securing old goalposts with a counterweight. (+info)
Risk of upper limb injury in left handed children: a study in Greece.
OBJECTIVES: To investigate whether left handed children are at increased risk for injuries, particularly upper limb injuries. SETTING: Athens, Greece, during a six month period in 1995-96. METHODS: Cases were 129 children 4-14 years old with unintentional upper limb injuries from a population based injury database. Two control children matched for gender and age were selected from among those seen at the same medical institution for minor, non-injury ailments. On the basis of information provided by the children and their guardians, sociodemographic variables were recorded, hand preference was assessed, and each child's activity score was calculated through an abbreviated version of Achenbach's scale. RESULTS: Left handed children have a moderately increased upper limb injury risk with a tendency of recurrence of this injury. The risk of upper limb injury is also raised among children of young fathers, whereas it appears to be inversely related to crowding index and activity score--three variables that were controlled for as potential confounders. CONCLUSIONS: This study provides limited support for the hypothesis that left handed children are at increased risk for injury. The excess risk, if genuine, is likely to be limited to cultural settings in which right handedness is perceived as the norm. (+info)
Late repair of simultaneous bilateral distal biceps brachii tendon avulsion with fascia lata graft.
A 50 year old rock climber sustained a bilateral rupture of the distal biceps brachii tendons. He retained some flexion power in both arms but minimal supination, being weaker on the non-dominant right side. As the patient presented late, with retraction and shortening of the biceps muscle bellies, reconstruction was carried out using fascia lata grafts on both sides. Because of residual weakness on the left (dominant) side, three further surgical procedures had to be carried out to correct for elongation of the graft. A functionally satisfactory outcome, comparable with that on the right side, was eventually obtained. In summary, bilateral fascia lata grafts to bridge the gap between the retracted biceps bellies and the radial tuberosities were successful in restoring function and flexion power to the elbow. Despite being the stronger side, the dominant arm did not respond as well to the initial surgery. This may be due to overuse of this arm after the operation. (+info)
Vascular injuries of the limbs: a fifteen-year Georgian experience.
OBJECTIVES: to analyse the causes of injury, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs in patients with vascular injuries operated on over a period between 1981 and 1995. PATIENTS: in 157 patients, the injuries were penetrating in 136 cases and blunt in 21. Isolated vascular trauma was present in 92 (58.6%) patients, 65 cases (41.4%) were aggrevated by concomitant bone fractures, severe nerve and soft tissue damage. The most frequently injured vessels were the superficial femoral (20. 6%) and brachial (19.1%) arteries. RESULTS: saphenous vein interposition grafting was applied with good results in 34 patients, polytetrafluoroethylene grafts were used in three cases, end-to-end anastomoses in 42 cases, venous bypasses in five cases, and venous patches in seven cases. Seventeen patients underwent arterial repair and nine, venous repair. Fasciotomy was used in 18 cases, and vessels were ligated in 14 cases. Blood flow was restored in 91 patients (58.0%), and collaterals compensated in 31 cases (19.7%). Fourteen primary and nine secondary amputations were performed. Twelve patients died. The limb salvage rate was 77.7% (84.1% among surviving patients). CONCLUSIONS: most vascular injuries associated with limb trauma can be managed successfully unless associated by severe concomitant damage to bones, nerves and soft tissues. (+info)
Transcranial doppler detection of fat emboli.
BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. METHODS: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications. (+info)
Seasonal variations in incidence of fractures among elderly people.
OBJECTIVE: To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older. POPULATION AND METHODS: A prospective, population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997, a total of 459,904 person years. Cases were identified through a prospective registration system. RESULTS: There were 10,992 (2390 per 100,000 person years) fall related fractures. The risk was higher in the colder seasons (October through March) among people aged 65-79 years (relative risk (RR) = 1.39, 95% confidence interval (CI) 1.32 to 1.47) and in people aged 80 years and older (RR = 1.17, 95% CI 1.09 to 1.22). For arm fractures, the RR was 1.69 (95% CI 1.56 to 1.83) among people aged 65-79 years and 1.30 (95% CI 1.13 to 1.43) among those aged 80 years and older. The RR for hip fractures was 1.27 (95% CI 1.15 to 1.37) among people aged 65-79 years and 1.08 (95% CI 1.00 to 1.15) for people aged 80 years and older. Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months. CONCLUSION: Season affects the incidence of all types of fractures in elderly people. Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect. Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture, but the size of the effect is difficult to estimate with certainty. (+info)