Cancellous screw fixation for femoral neck fractures: one hundred and sixteen patients.
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INTRODUCTION: This paper evaluates the efficacy and safety of the use of cancellous screw fixation in the treatment of intracapsular femoral neck fractures in our local population. MATERIALS AND METHODS: A retrospective analysis of the results of 116 cases that were performed in Singapore General Hospital and Changi General Hospital over a 2-year period was undertaken. The minimum period of follow-up was 2 years. RESULTS: The median age of the study group was 71 years and approximately two-thirds were females. There were 104 (90%) cases of undisplaced (Garden 1 and 2) fractures and 12 (10%) displaced (Garden 3 and 4) fractures. The specific complication rate was much higher in the displaced group of patients. At 2 years' postoperation, 85% returned to their premorbid level of ambulation and 90% reported good pain relief. The 1-year mortality rate was 7%. CONCLUSION: Cancellous screw fixation is a relatively safe and useful operation. It achieved our aim of returning most patients to their pre-fracture level of ambulation and providing good pain relief. (+info)
Posttraumatic Stress Disorder in patients with traumatic brain injury.
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BACKGROUND: Severe traumatic stressors such as war, rape, or life-threatening accidents can result in a debilitating psychopathological development conceptualised as Posttraumatic Stress Disorder (PTSD). Pathological memory formation during an alarm response may set the precondition for PTSD to occur. If true, a lack of memory formation by extended unconsciousness in the course of the traumatic experience should preclude PTSD. METHODS: 46 patients from a neurological rehabilitation clinic were examined by means of questionnaires and structured clinical interviews. All patients had suffered a TBI due to an accident, but varied with respect to falling unconscious during the traumatic event. RESULTS: 27% of the sub-sample who were not unconscious for an extended period but only 3% (1 of 31 patients) who were unconscious for more than 12 hours as a result of the accident were diagnosed as having current PTSD (P <.02). Furthermore, intrusive memories proved to be far more frequent in patients who had not been unconscious. This was also the case for other re-experiencing symptoms and for psychological distress and physiological reactivity to reminders of the traumatic event. CONCLUSION: TBI and PTSD are not mutually exclusive. However, victims of accidents are unlikely to develop a PTSD if the impact to the head had resulted in an extended period of unconsciousness. (+info)
Effect of trail design and grooming on the incidence of injuries at alpine ski areas.
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OBJECTIVES: To identify the conditions at certain sites on slopes known as black spots for injury. METHOD: In the Hafjell and Voss alpine ski areas in Norway, 1410 skiing injuries were recorded from December 1990 through the 1996 season. In Hafjell, 183 of these injuries were plotted on an area map during the two first seasons. Similarly, in Voss, 214 injuries were plotted on an area map for two seasons. During the last three seasons in Hafjell, 835 ski injuries were related to 6712 snow grooming hours and 6,829,084 lift journeys. RESULTS: The mean injury rate was 2.2 injuries per 1000 skier days, and the mean injury severity score (ISS) was 3.1. Accumulations of injuries at three sites (black spots) were recorded on the Hafjell area map. These injuries represented 40% of all injuries in the alpine area (p<0.05). Seven injury accumulation sites were recorded on the alpine area map of Voss, representing 22% of the total injuries (p>0.05). Grooming of the slopes was rated poor for the 49% of injuries that occurred at the sites of injury concentration and significantly different (27%) from injuries that occurred at random in Hafjell. The corresponding values in Voss were 50% and 25% respectively. Grooming hours appeared to be inversely proportional to the number of injuries: R = -0.99 (p<0.02). The mean ISS declined significantly in Hafjell over the observation period (p<0.001). CONCLUSION: Inappropriate trail design and slope grooming seem to result in an accumulation of injuries at certain sites. Modification in construction and maintenance of the courses may reduce the number of injuries and mean ISS. (+info)
Profile of children with head injuries treated at the trauma unit of Red Cross War Memorial Children's Hospital, 1991 - 2001.
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OBJECTIVE: To describe the profile of childhood head injury patients treated in a trauma unit. DESIGN: A retrospective record-based study. SETTING: The trauma unit of the Red Cross War Memorial Children's Hospital. SUBJECTS: Children (under 13 years of age) presenting with head injuries between January 1991 and December 2001. RESULTS: Of the almost 94 000 records, more than one-third were children presenting with head injuries. Fifty-nine per cent were boys, with more than half the sample under 5 years of age. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights, and traffic-related injuries. Almost two-thirds of traffic-related injuries involved children as pedestrians being struck by a motor vehicle. More than 60% of injuries occurred in or around the child's own home. CONCLUSIONS: Head injuries in children are a significant cause of morbidity. Prevention, especially in the home and on the streets, needs urgent attention. (+info)
Nonfatal childhood injuries: a survey at the Children's Hospital of eastern Ontario.
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OBJECTIVE: To examine the types and severity of injuries seen in the Emergency Department of the Children's Hospital of Eastern Ontario and the circumstances surrounding the events. DESIGN: Chart review. SETTING: A tertiary care hospital that serves a child population of 600,000 in eastern Ontario and western Quebec. PARTICIPANTS: Every sixth day's charts of children up to 17 years of age who visited the Emergency Department because of injuries between Sept. 1, 1984, and Aug. 31, 1985, were examined retrospectively. RESULTS: A total of 2886 charts were reviewed. There were more boys than girls. Most (1354 [46.9%]) of the accidents had occurred at home. Falls and sports-related accidents were the leading causes of injury (in 1088 [37.7%] and 560 [19.4%] of the cases respectively). Most of the visits were for minor injuries (bumps, swellings, cuts, bruises and scrapes), and only 114 (4.0%) of the children were admitted to the hospital. Injuries from motor vehicle accidents accounted for the highest admission rate (17.4%). Important information regarding the circumstances surrounding the events (e.g., whether a seat belt or car seat was used) was frequently missing from the charts. CONCLUSIONS: Nonfatal injuries are common, especially in or around the home, and remain a significant problem in our society in terms of radiographic and consulting fees, time off from school or work and pain. Given the difficulties in obtaining information on the circumstances surrounding the events prospective studies are needed. Factors related to the occurrence and severity of childhood injury and whether these factors can be altered remain a high priority for research. (+info)
The role of clinical examination in excluding vascular injury in haemodynamically stable patients with gunshot wounds to the neck. A prospective study of 59 patients.
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OBJECTIVE: To prospectively evaluate the safety and accuracy of physical examination in determining the management of stable patients with gunshot wounds to the neck. DESIGN: Prospective study of 59 patients with gunshot wounds to the neck. PATIENTS AND METHODS: Fifty-nine stable patients with gunshot wounds to the neck managed between December 2001 and August 2003. All patients had a physical examination and routine angiography according to a written protocol approved by the research ethics committee. The sensitivity, specificity, and predictive values of physical examination were assessed and compared with the angiographic findings. RESULTS: Thirteen patients with positive findings on physical examination (history of bleeding, haematoma, minimal bleeding, thrill, bruit and pulse deficit) and 10 patients without clinical signs of vascular injury had vascular injury. A sensitivity of 57%, specificity 53%, positive predictive value 43% and negative predictive value of 67% were calculated for physical examination alone in detecting vascular injury. CONCLUSION: Findings on physical examination are not good predictors of vascular injury in stable patients with gunshot wounds to the neck. Our findings question the validity of physical examination alone, as a safe and accurate assessment of patients with gunshot wounds to the neck. Arteriography or ultrasonography is needed to identify vascular injuries. (+info)
Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review.
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INTRODUCTION: Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. METHODS: The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay. RESULTS: Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean +/- standard error: 9.6 +/- 1.2 days versus 18.7 +/- 1.3 days; P < 0.0001). Similarly, ICU LOS was significantly shorter (10.9 +/- 1.2 days versus 21.0 +/- 1.3 days; P < 0.0001). Following tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 +/- 1.2 days versus 4.9 +/- 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of prolonged ICU stay (>14 days). CONCLUSION: Early tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients may help in reducing unnecessary resource utilization. (+info)
International Collaborative Effort on Injury Statistics: 10 year review.
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International comparisons of injury data may be useful for examining differences in risk and for suggesting potential interventions or hypotheses for future studies. However important issues to be considered in conducting comparisons are related to both the underlying quality of the data and how the data are collected. The International Collaborative Effort (ICE) on Injury Statistics grew out of concerns over the comparability of international injury data. This article outlines the history behind the development of the Injury ICE, brief descriptions of current and past projects, collaborations, and reflections on the value of collaboration. (+info)