A Study of Skull Fractures in Cases of Fall from Height
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Cervical Spine Injury Risk Factors in Children with Blunt Trauma Julie C
Cervical Spine Injury Risk Factors in Children With Blunt Trauma Julie C. Leonard, MD, MPH,a Lorin R. Browne, DO,b Fahd A. Ahmad, MD, MSCI,c Hamilton Schwartz, MD, MEd,d Michael Wallendorf, PhD,e Jeffrey R. Leonard, MD,f E. Brooke Lerner, PhD,b Nathan Kuppermann, MD, MPHg BACKGROUND: Adult prediction rules for cervical spine injury (CSI) exist; however, pediatric rules abstract do not. Our objectives were to determine test accuracies of retrospectively identified CSI risk factors in a prospective pediatric cohort and compare them to a de novo risk model. METHODS: We conducted a 4-center, prospective observational study of children 0 to 17 years old who experienced blunt trauma and underwent emergency medical services scene response, trauma evaluation, and/or cervical imaging. Emergency department providers recorded CSI risk factors. CSIs were classified by reviewing imaging, consultations, and/or telephone follow-up. We calculated bivariable relative risks, multivariable odds ratios, and test characteristics for the retrospective risk model and a de novo model. RESULTS: Of 4091 enrolled children, 74 (1.8%) had CSIs. Fourteen factors had bivariable associations with CSIs: diving, axial load, clotheslining, loss of consciousness, neck pain, inability to move neck, altered mental status, signs of basilar skull fracture, torso injury, thoracic injury, intubation, respiratory distress, decreased oxygen saturation, and neurologic deficits. The retrospective model (high-risk motor vehicle crash, diving, predisposing condition, neck pain, decreased neck mobility (report or exam), altered mental status, neurologic deficits, or torso injury) was 90.5% (95% confidence interval: 83.9%–97.2%) sensitive and 45.6% (44.0%–47.1%) specific for CSIs. -
Septation of the Sphenoid Sinus and Its Clinical Significance
1793 International Journal of Collaborative Research on Internal Medicine & Public Health Septation of the Sphenoid Sinus and its Clinical Significance Eldan Kapur 1* , Adnan Kapidžić 2, Amela Kulenović 1, Lana Sarajlić 2, Adis Šahinović 2, Maida Šahinović 3 1 Department of anatomy, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina 2 Clinic for otorhinolaryngology, Clinical centre University of Sarajevo, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina 3 Department of histology and embriology, Medical faculty, University of Sarajevo, Čekaluša 90, 71000 Sarajevo, Bosnia and Herzegovina * Corresponding Author: Eldan Kapur, MD, PhD Department of anatomy, Medical faculty, University of Sarajevo, Bosnia and Herzegovina Email: [email protected] Phone: 033 66 55 49; 033 22 64 78 (ext. 136) Abstract Introduction: Sphenoid sinus is located in the body of sphenoid, closed with a thin plate of bone tissue that separates it from the important structures such as the optic nerve, optic chiasm, cavernous sinus, pituitary gland, and internal carotid artery. It is divided by one or more vertical septa that are often asymmetric. Because of its location and the relationships with important neurovascular and glandular structures, sphenoid sinus represents a great diagnostic and therapeutic challenge. Aim: The aim of this study was to assess the septation of the sphenoid sinus and relationship between the number and position of septa and internal carotid artery in the adult BH population. Participants and Methods: A retrospective study of the CT analysis of the paranasal sinuses in 200 patients (104 male, 96 female) were performed using Siemens Somatom Art with the following parameters: 130 mAs: 120 kV, Slice: 3 mm. -
The Dynamic Impact Behavior of the Human Neurocranium
www.nature.com/scientificreports OPEN The dynamic impact behavior of the human neurocranium Johann Zwirner1,2*, Benjamin Ondruschka2,3, Mario Scholze4,5, Joshua Workman6, Ashvin Thambyah6 & Niels Hammer5,7,8 Realistic biomechanical models of the human head should accurately refect the mechanical properties of all neurocranial bones. Previous studies predominantly focused on static testing setups, males, restricted age ranges and scarcely investigated the temporal area. This given study determined the biomechanical properties of 64 human neurocranial samples (age range of 3 weeks to 94 years) using testing velocities of 2.5, 3.0 and 3.5 m/s in a three-point bending setup. Maximum forces were higher with increasing testing velocities (p ≤ 0.031) but bending strengths only revealed insignifcant increases (p ≥ 0.052). The maximum force positively correlated with the sample thickness (p ≤ 0.012 at 2.0 m/s and 3.0 m/s) and bending strength negatively correlated with both age (p ≤ 0.041) and sample thickness (p ≤ 0.036). All parameters were independent of sex (p ≥ 0.120) apart from a higher bending strength of females (p = 0.040) for the 3.5 -m/s group. All parameters were independent of the post mortem interval (p ≥ 0.061). This study provides novel insights into the dynamic mechanical properties of distinct neurocranial bones over an age range spanning almost one century. It is concluded that the former are age-, site- and thickness-dependent, whereas sex dependence needs further investigation. Biomechanical parameters characterizing the load-deformation behavior of the human neurocranium are crucial for building physical models 1–3 and high-quality computational simulations 4–6 of the human head to answer com- plex biomechanical research questions to the best possible extent. -
Clinical Features and Treatment of Pediatric Orbit Fractures
ORIGINAL INVESTIGATION Clinical Features and Treatment of Pediatric Orbit Fractures Eric M. Hink, M.D.*, Leslie A. Wei, M.D.*, and Vikram D. Durairaj, M.D., F.A.C.S.*† Departments of *Ophthalmology, and †Otolaryngology and Head and Neck Surgery, University of Colorado Denver, Aurora, Colorado, U.S.A. of craniofacial skeletal development.1 Orbit fractures may be Purpose: To describe a series of orbital fractures and associated with ophthalmic, neurologic, and craniofacial inju- associated ophthalmic and craniofacial injuries in the pediatric ries that may require intervention. The result is that pediatric population. facial trauma is often managed by a diverse group of specialists, Methods: A retrospective case series of 312 pediatric and each service may have their own bias as to the ideal man- patients over a 9-year period (2002–2011) with orbit fractures agement plan.4 In addition, children’s skeletal morphology and diagnosed by CT. physiology are quite different from adults, and the benefits of Results: Five hundred ninety-one fractures in 312 patients surgery must be weighed against the possibility of detrimental were evaluated. There were 192 boys (62%) and 120 girls (38%) changes to facial skeletal growth and development. The purpose with an average age of 7.3 years (range 4 months to 16 years). of this study was to describe a series of pediatric orbital frac- Orbit fractures associated with other craniofacial fractures were tures; associated ophthalmic, neurologic, and craniofacial inju- more common (62%) than isolated orbit fractures (internal ries; and fracture management and outcomes. fractures and fractures involving the orbital rim but without extension beyond the orbit) (38%). -
In Drivers of Open-Wheel Open Cockpit Race Cars
SPORTS MEDICINE SPINE FRACTURES IN DRIVERS OF OPEN-WHEEL OPEN COCKPIT RACE CARS – Written by Terry Trammell and Kathy Flint, USA This paper is intended to explain the mechanisms responsible for production of spinal fracture in the driver of an open cockpit single seat, open-wheel racing car (Indy Car) and what can be done to lessen the risk of fracture. In a report of fractures in multiple racing • Seated angle (approximately 45°) • Lumbar spine flexed series drivers (Championship Auto Racing • Hips and knees flexed • Seated semi-reclining Cars [CART]/Champ cars, Toyota Atlantics, Indy Racing League [IRL], Indy Lights and Figure 1: Body alignment in the Indy Car. Formula 1 [F1]), full details of the crash and mechanism of injury were captured and analysed. This author was the treating physician in all cases from 1996 to 2011. All images, medical records, data available BASILAR SKULL FRACTURE Use of this specific safety feature from the Accident Data Recorder-2 (ADR), Following a fatal distractive basilar is compulsory in most professional crash video, specific on track information, skull fracture in 1999, the Head and Neck motorsport sanctions and has resulted in a post-accident investigation of damage and Support (HANS) device was introduced into dramatic reduction to near elimination of direction of major impact correlated with Indy Cars. Basilar skull fracture occurs when fatal basilar skull fractures. No basilar skull ADR-2 data were analysed. Results provided neck tension exceeds 3113.75 N forces. fractures have occurred in the IRL since the groundwork for understanding spine No data demonstrates that HANS introduction of the HANS and since 2006 fracture and forces applied to the driver in predisposes the wearer to other cervical there has been only one cervical fracture. -
EM Cases Digest Vol. 1 MSK & Trauma
THE MAGAZINE SERIES FOR ENHANCED EM LEARNING Vol. 1: MSK & Trauma Copyright © 2015 by Medicine Cases Emergency Medicine Cases by Medicine Cases is copyrighted as “All Rights Reserved”. This eBook is Creative Commons Attribution-NonCommercial- NoDerivatives 3.0 Unsupported License. Upon written request, however, we may be able to share our content with you for free in exchange for analytic data. For permission requests, write to the publisher, addressed “Attention: Permissions Coordinator,” at the address below. Medicine Cases 216 Balmoral Ave Toronto, ON, M4V 1J9 www.emergencymedicinecases.com This book has been authored with care to reflect generally accepted practices. As medicine is a rapidly changing field, new diagnostic and treatment modalities are likely to arise. It is the responsibility of the treating physician, relying on his/her experience and the knowledge of the patient, to determine the best management plan for each patient. The author(s) and publisher of this book are not responsible for errors or omissions or for any consequences from the application of the information in this book and disclaim any liability in connection with the use of this information. This book makes no guarantee with respect to the completeness or accuracy of the contents within. OUR THANKS TO... EDITORS IN CHIEF Anton Helman Taryn Lloyd PRODUCTION EDITOR Michelle Yee PRODUCTION MANAGER Garron Helman CHAPTER EDITORS Niran Argintaru Michael Misch PODCAST SUMMARY EDITORS Lucas Chartier Keerat Grewal Claire Heslop Michael Kilian PODCAST GUEST EXPERTS Andrew Arcand Natalie Mamen Brian Steinhart Mike Brzozowski Hossein Mehdian Arun Sayal Ivy Cheng Sanjay Mehta Laura Tate Walter Himmel Jonathan Pirie Rahim Valani Dave MacKinnon Jennifer Riley University of Toronto, Faculty of Medicine EM Cases is a venture of the Schwartz/ Reisman Emergency Medicine Institute. -
Morfofunctional Structure of the Skull
N.L. Svintsytska V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 Ministry of Public Health of Ukraine Public Institution «Central Methodological Office for Higher Medical Education of MPH of Ukraine» Higher State Educational Establishment of Ukraine «Ukranian Medical Stomatological Academy» N.L. Svintsytska, V.H. Hryn Morfofunctional structure of the skull Study guide Poltava 2016 2 LBC 28.706 UDC 611.714/716 S 24 «Recommended by the Ministry of Health of Ukraine as textbook for English- speaking students of higher educational institutions of the MPH of Ukraine» (minutes of the meeting of the Commission for the organization of training and methodical literature for the persons enrolled in higher medical (pharmaceutical) educational establishments of postgraduate education MPH of Ukraine, from 02.06.2016 №2). Letter of the MPH of Ukraine of 11.07.2016 № 08.01-30/17321 Composed by: N.L. Svintsytska, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor V.H. Hryn, Associate Professor at the Department of Human Anatomy of Higher State Educational Establishment of Ukraine «Ukrainian Medical Stomatological Academy», PhD in Medicine, Associate Professor This textbook is intended for undergraduate, postgraduate students and continuing education of health care professionals in a variety of clinical disciplines (medicine, pediatrics, dentistry) as it includes the basic concepts of human anatomy of the skull in adults and newborns. Rewiewed by: O.M. Slobodian, Head of the Department of Anatomy, Topographic Anatomy and Operative Surgery of Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Doctor of Medical Sciences, Professor M.V. -
Depressed Skull Fracture (Let's Talk About
In partnership with Primary Children’s Hospital Let’s Talk About... Depressed Skull Fracture B. A. Depressed skull Indentation fracture C. Concussion A depressed skull fracture happens when one or more to be removed. Before the surgery, your child’s head fragments of the skull bone are pushed inward (see is shaved so the surgery can be completely clean. Your “B” on the illustration). An indentation (A) with no child also receives some medicine to help him or her breaks in the bone happens more often in babies. relax and sleep. During surgery, small metal plates Since the brain is beneath the skull, the skull bone and screws may be used to hold the bone fragments fragments may injure the brain (C). Your child may in place. The skin over the surgical area is closed with have a bruise on the brain (called a contusion), and sutures (SOO-churs) or skin staples. a swollen black-and-blue area on the skin. What happens after the surgery? How do you treat a depressed After the surgery, your child will stay in the hospital skull fracture? for a few days. There is a lot of equipment around To find out if your child has a skull fracture, a special the bed. This helps the staff care for your child. x-ray called a CT Scan (short for computerized While your child is in the hospital, the nurses tomography) is needed. The CT scan takes pictures of frequently check your child’s temperature, pulse, your child’s brain and skull bones. blood pressure, and alertness. -
Biomechanics of Temporo-Parietal Skull Fracture Narayan Yoganandan *, Frank A
Clinical Biomechanics 19 (2004) 225–239 www.elsevier.com/locate/clinbiomech Review Biomechanics of temporo-parietal skull fracture Narayan Yoganandan *, Frank A. Pintar Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA Received 16 December 2003; accepted 16 December 2003 Abstract This paper presents an analysis of research on the biomechanics of head injury with an emphasis on the tolerance of the skull to lateral impacts. The anatomy of this region of the skull is briefly described from a biomechanical perspective. Human cadaver investigations using unembalmed and embalmed and intact and isolated specimens subjected to static and various types of dynamic loading (e.g., drop, impactor) are described. Fracture tolerances in the form of biomechanical variables such as peak force, peak acceleration, and head injury criteria are used in the presentation. Lateral impact data are compared, where possible, with other regions of the cranial vault (e.g., frontal and occipital bones) to provide a perspective on relative variations between different anatomic regions of the human skull. The importance of using appropriate instrumentation to derive injury metrics is underscored to guide future experiments. Relevance A unique advantage of human cadaver tests is the ability to obtain fundamental data for delineating the biomechanics of the structure and establishing tolerance limits. Force–deflection curves and acceleration time histories are used to derive secondary variables such as head injury criteria. These parameters have direct application in safety engineering, for example, in designing vehicular interiors for occupant protection. Differences in regional biomechanical tolerances of the human head have implications in clinical and biomechanical applications. -
Comparison of Diagnostic Accuracy of Bedside Ultrasonography and Radiography for Calcaneal Fractures in the Emergency Department
Open Access http://jept.ir Publish Free doi 10.34172/jept.2020.36 Journal of Emergency Practice and Trauma Original Article Volume 7, Issue 1, 2021, 2020, p. 17-21 Comparison of diagnostic accuracy of bedside ultrasonography and radiography for calcaneal fractures in the emergency department Majid Zamani ID , Maliheh Mazaheri ID , Farhad Heydari* ID , Babak Masoumi ID Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Received: 1 June 2020 Abstract Accepted: 14 September 2020 Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal Published online: 24 September fractures. The aim of this study was to compare the diagnostic accuracy of US with plain 2020 radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. *Corresponding author: Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the Farhad heydari; Emergency emergency department (ED) with suspicion of traumatic calcaneus fracture following acute Medicine Specialist; Department of Emergency Medicine, Faculty blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by of Medicine, Isfahan University of emergency physicians. After that, plain radiography was performed. Furthermore, all the Medical Sciences, Isfahan, Iran patients were assessed by computed tomography (CT) scan as the gold standard. Alzahra Hospital, Sofeh Ave, Keshvari Results: Finally, 193 patients were enrolled with a mean age of 29.4 ± 15.7 years (85.5% Blvd., Isfahan, Iran. male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity Tel: +989131367643; Email: [email protected] of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray Competing interests: None. -
Talo-Calcaneal Distraction Ilizarov Frame: an Ergonomic Method to Manage Intra-Articular Fractures of Calcaneum
ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES Talo-calcaneal distraction Ilizarov frame: an ergonomic method to manage intra-articular fractures of calcaneum Anoop Raj Singh1, Javed Ahmad 2, Vivek Kumar Shrivastava3, Pavneesh Kumar4 1Assistant Professor, Department of Orthopedics, SMMH Medical College, Saharanpur, Uttar Pradesh, India, 2,3Assistant Professor, Department of Orthopedics, Mahamaya Rajkiya Allopathic Medical College, Ambedkar Nagar, Uttar Pradesh, India, SMMH Medical College, Saharanpur, Uttar Pradesh, India, 4Assistant Professor, Department of Orthopedics, Government Doon Medical College Dehradun, India Submission: 07-03-2021 Revision: 27-05-2021 Publication: 01-07-2021 ABSTRACT Background: Principle of distraction and an indirect reduction was used to promote healing of Access this article online fractures and adequate regeneration of cartilage at the subtalar joint. Aims and Objectives: The Website: study was aimed to elaborate and develop role of Ilizarov as an alternative biological method to manage intraarticular fracture calcaneum with minimal chances of infection. http://nepjol.info/index.php/AJMS Materials and Methods: Twenty-one patients were studied and the mean age of patients DOI: 10.3126/ajms.v12i7.35459 was 40.7 years (span: 20 to 65 years). Sanders CT classification was used to divide into E-ISSN: 2091-0576 type II, 11 (52.38%); type III, 7 (33.33%) and type IV, 3 (14.28%). The average follow-up P-ISSN: 2467-9100 was 17.2 months (range: 6 to 24 months). AOFAS scale for ankle and hindfoot was used for assessment of patients- 7 (33.33%) excellent, 7 (33.33%) good, 3 (14.28%) fair, and 4 Copyright (c) 2021 Asian Journal of (19.04%) poor results. -
Calcaneal Fracture and Rehabilitation
1 Calcaneal Fracture and Rehabilitation Surgical Indications and Considerations Anatomic Considerations: The calcaneus articulates with the talus superiorly at the subtalar joint. The three articulating surfaces of the subtalar joint are the: anterior, middle, and posterior facets, with the posterior facet representing the major weight-bearing surface. The subtalar joint is responsible for the majority of foot inversion/eversion (or pronation/supination). The interosseous ligament and medial, lateral, and posterior talocalcaneal ligaments provide additional support for the joint. The tibial artery, nerve, posterior tibial tendon, and flexor hallucis longus tendon are located medially to the calcaneus and are at risk for impingement with a calcaneal fracture, as are the peroneal tendons located on the lateral aspect of the calcaneus. The calcaneus serves three major functions: 1) acts as a foundation and support for the body’s weight, 2) supports the lateral column of the foot and acts as the main articulation for inversion/eversion, and 3) acts as a lever arm for the gastrocnemius muscle complex. Pathogenesis: Fractures of the calcaneal body, anterior process, sustentaculum tali, and superior tuberosity are known as extra-articular fractures and usually occur as a result of blunt force or sudden twisting. Fractures involving any of the three subtalar articulating surfaces are known as intra-articular fractures and are common results of: a fall from a height usually 6 feet or more, a motor vehicle accident (MVA), or an impact on a hard surface while running or jumping. Intra-articular fractures are commonly produced by axial loading; a combination of shearing and compression forces produce both the primary and secondary fracture lines.