Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004.
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OBJECTIVE: Our objective for this study was to describe the epidemiology of lawn mower-related injuries among children in the United States. METHODS: A retrospective analysis was conducted of data from children who were 20 years and younger in the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990-2004. RESULTS: There were an estimated 140700 lawn mower-related injuries to children who were 20 years and younger and treated in hospital emergency departments in the United States during the 15-year period of 1990-2004. This yielded an average of 9400 injuries annually, or 11.1 injuries per 100000 US children per year. The mean age was 10.7 (SD: 6.0) years, and 78% were boys. The leading type of lawn mower-related injury sustained by patients was a laceration (41.2%), followed by soft tissue injury (21.4%), burn (15.5%), and fracture (10.3%). The most common body region injured was the hand/finger (34.6%), followed by lower extremity (18.9%) and foot/toe (17.7%). The eyeball/face and upper extremity accounted for 10.6% and 7.4% of injuries, respectively. Burns accounted for 34.5% of injuries to the hand/finger compared with 5.5% to other body regions. Ninety-seven percent of amputation injuries occurred to the foot/toe (49.5%) and hand/finger (47.5%) compared with 3% of amputations to other body regions. Burns accounted for 41.8% of injuries among children who were < or = 5 years of age compared with 6.5% of injuries to children who were older than 5 years. Foreign body injuries accounted for 4.8% of injuries among children who were > or = 12 years of age compared with 1.6% of injuries to children who were younger than 12 years. Amputations (31.9%), lacerations (28.8%), and fractures (26.0%) accounted for almost 87% of injuries among children who were admitted or transferred to another hospital. In contrast, lacerations (42.3%), soft tissue injuries (23.3%), and burns (16.9%) predominated among children who were treated and released to home from the emergency department. Children with amputations were more likely to be admitted than children with other types of injury. CONCLUSIONS: Injuries related to lawn mowers are an important cause of pediatric morbidity. The relative consistency of the number of lawn mower-related injuries to children during the 15-year study period is evidence that current prevention strategies are inadequate. Passive protection that is provided by safer product design is the strategy with the highest likelihood of success in preventing these ongoing injuries. The lawn mower voluntary safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all ride-on lawn mowers with a no-mow-in-reverse default feature with location of its override switch behind the seating position of the ride-on mower operator. By locating the no-mow-in-reverse override switch behind the ride-on mower operator, the operator would be required to look behind the mower before mowing in reverse. (+info)
Topical ketoprofen TDS patch versus diclofenac gel: efficacy and tolerability in benign sport related soft-tissue injuries.
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OBJECTIVE: To compare the ketoprofen TDS patch with diclofenac gel in the treatment of traumatic acute pain in benign sport-related soft-tissue injuries. DESIGN: 7-14 treatment days, prospective, randomised, open study. PATIENTS: Outpatients aged 18-70 years diagnosed for painful benign sport-related soft-tissue injury (sprains, strains and contusions within the prior 48 h), randomised to either ketoprofen patch 100 mg once daily (n = 114) or diclofenac gel 2-4 g three times daily (n = 109). INTERVENTION: 7-14 days of topical non-steroidal anti-inflammatory drugs treatment to assess the pain intensity changes (daily activities and spontaneous at rest) in a daily diary (100-mm Visual Analogue Scale (VAS)). MAIN OUTCOME MEASUREMENT: Pain intensity (VAS). RESULTS: The ketoprofen patch was not inferior to diclofenac gel in reducing the baseline pain during daily activities (difference of -1.17 mm in favour of ketoprofen patch, 95% CI (-5.86 to 3.52), reducing to the baseline VAS 79%. Ketoprofen patch presented also a higher cure rate (64%) than diclofenac gel (46%) at day 7 (p = 0.004). Patient opinions about the treatment comfort (pharmaceutical shape, application and dosage) were also statistically higher for the ketoprofen patch (>80% of the patients rated as good or excellent the patch removal and skin adherence). CONCLUSION: Ketoprofen patches are effective and safe pain relievers for the treatment of sports injury pain with advantages compared with diclofenac gel. (+info)
Adolescent musculoskeletal injuries in a football academy.
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Interest in football continues to increase, with ever younger age groups participating at a competitive level. Football academies have sprung up under the umbrella of professional clubs in an attempt to nurture and develop such talent in a safe manner. However, increased participation predisposes the immature skeleton to injury. Over a five-year period we have prospectively collected data concerning all injuries presenting to the medical team at Newcastle United football academy. We identified 685 injuries in our cohort of 210 players with a mean age of 13.5 years (9 to 18). The majority of injuries (542;79%) were to the lower limb. A total of 20 surgical procedures were performed. Contact injuries accounted for 31% (210) of all injuries and non-contact for 69% (475). The peaks of injury occurred in early September and March. The 15- and 16-year-old age group appeared most at risk, independent of hours of participation. Strategies to minimise injury may be applicable in both the academy setting and the wider general community. (+info)
Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia.
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We have managed 21 patients with a fracture of the tibia complicated by bone and soft-tissue loss as a result of an open fracture in 10, or following debridement of an infected nonunion in 11, by resection of all the devitalised tissues, acute limb shortening to close the defect, application of an external fixator and metaphyseal osteotomy for re-lengthening. The mean bone loss was 4.7 cm (3 to 11). The mean age of the patients was 28.8 years (12 to 54) and the mean follow-up was 34.8 months (24 to 75). All the fractures united with a well-aligned limb. The mean duration of treatment for the ten grade-III A+B open fractures (according to the Gustilo-Anderson classification) was 5.7 months (4.5 to 8) and for the nonunions, 7.6 months (5.5 to 12.5). Complications included one refracture, one transient palsy of the peroneal nerve and one equinus contracture of 10 degrees . (+info)
Gene therapy and wound healing.
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Wound repair involves the sequential interaction of various cell types, extracellular matrix molecules, and soluble mediators. During the past 10 years, much new information on signals controlling wound cell behavior has emerged. This knowledge has led to a number of novel therapeutic strategies. In particular, the local delivery of pluripotent growth factor molecules to the injured tissue has been intensively investigated over the past decade. Limited success of clinical trails indicates that a crucial aspect of the growth factor wound healing strategy is the effective delivery of these polypeptides to the wound site. A molecular approach in which genetically modified cells synthesize and deliver the desired growth factor in regulated fashion has been used to overcome the limitations associated with the (topical) application of recombinant growth factor proteins. We have summarized the molecular and cellular basis of repair mechanisms and their failure, and we give an overview of techniques and studies applied to gene transfer in tissue repair. (+info)
Do emergency department physiotherapy practitioner's, emergency nurse practitioners and doctors investigate, treat and refer patients with closed musculoskeletal injuries differently?
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INTRODUCTION: This paper aims to assess whether emergency department physiotherapy practitioner's (EDPPs), emergency nurse practitioner's (ENPs) and emergency department doctors investigate, treat and refer patients with closed musculoskeletal injuries differently. METHOD: The emergency department records of patients who fitted the departmental criteria for being treated by either ENPs, EDPPs or doctors were selected retrospectively during a 2 1/2 month period between 1 March and 15 May 2005. The investigation, management and referral or discharge of these patients were analysed. RESULTS: There was no significant difference between the proportion of patients sent for x ray and the type of clinician. (p = 0.17) There was also no significant difference between the proportions of x rays found to have fractures/dislocations with each type of clinician (p = 0.99). All fractures and dislocations were found to have been managed following the written departmental protocols. Consequently, further analysis was for soft tissue injuries only. For soft tissue injuries, senior house officers gave more patients analgesia/non-steroidal anti-inflammatory drugs compared with other clinicians (86%, p<0.001). ENPs gave more structural support (bandages, etc) compared with other clinicians (80%, p<0.001). Consultant's arranged the least formal follow-up although this was not significant (7.6%, p = 0.054) and middle grades offered the most follow-up (17%, p = 0.054) with this again not being significant. However, EDPPs referred significantly more patients for physiotherapy follow-up (9.2%, p = 0.031). CONCLUSION: ENPs, EDPPs and doctors of all grades investigated patients with fractures and dislocations similarly and managed them following the written departmental guidelines. However, there were statistically significant differences in the way patients with closed soft tissue injuries were treated and followed-up. (+info)
Optical and acoustic monitoring of bubble cloud dynamics at a tissue-fluid interface in ultrasound tissue erosion.
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Short, high-intensity ultrasound pulses have the ability to achieve localized, clearly demarcated erosion in soft tissue at a tissue-fluid interface. The primary mechanism for ultrasound tissue erosion is believed to be acoustic cavitation. To monitor the cavitating bubble cloud generated at a tissue-fluid interface, an optical attenuation method was used to record the intensity loss of transmitted light through bubbles. Optical attenuation was only detected when a bubble cloud was seen using high speed imaging. The light attenuation signals correlated well with a temporally changing acoustic backscatter which is an excellent indicator for tissue erosion. This correlation provides additional evidence that the cavitating bubble cloud is essential for ultrasound tissue erosion. The bubble cloud collapse cycle and bubble dissolution time were studied using the optical attenuation signals. The collapse cycle of the bubble cloud generated by a high intensity ultrasound pulse of 4-14 micros was approximately 40-300 micros depending on the acoustic parameters. The dissolution time of the residual bubbles was tens of ms long. This study of bubble dynamics may provide further insight into previous ultrasound tissue erosion results. (+info)
Estrogen receptor-alpha predominantly mediates the salutary effects of 17beta-estradiol on splenic macrophages following trauma-hemorrhage.
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Although 17beta-estradiol administration following trauma-hemorrhage prevents the suppression in splenic macrophage cytokine production, it remains unknown whether the salutary effects are mediated via estrogen receptor (ER)-alpha or ER-beta and which signaling pathways are involved in such 17beta-estradiol effects. Utilizing ER-alpha- or ER-beta-specific agonists, this study examined the role of ER-alpha and ER-beta in 17beta-estradiol-mediated restoration of macrophage cytokine production following trauma-hemorrhage. In addition, since MAPK and NF-kappaB are known to regulate macrophage cytokine production, we also examined the activation of those signaling molecules. Male rats underwent trauma-hemorrhage (mean arterial pressure of 40 mmHg for 90 min) and fluid resuscitation. The ER-alpha agonist propyl pyrazole triol (PPT; 5 microg/kg), the ER-beta agonist diarylpropionitrile (DPN; 5 microg/kg), 17beta-estradiol (50 microg/kg), or vehicle (10% DMSO) was injected subcutaneously during resuscitation. Twenty-four hours thereafter, splenic macrophages were isolated, and their IL-6 and TNF-alpha production and activation of MAPK and NF-kappaB were measured. Macrophage IL-6 and TNF-alpha production and MAPK activation were decreased, whereas NF-kappaB activity was increased, following trauma-hemorrhage. PPT or 17beta-estradiol administration after trauma-hemorrhage normalized those parameters. DPN administration, on the other hand, did not normalize the above parameters. Since PPT but not DPN administration following trauma-hemorrhage was as effective as 17beta-estradiol in preventing the suppression in macrophage cytokine production, it appears that ER-alpha plays the predominant role in mediating the salutary effects of 17beta-estradiol on macrophage cytokine production following trauma-hemorrhage and that such effects are likely mediated via normalization of MAPK but not NF-kappaB signaling pathways. (+info)